Provider Demographics
NPI:1699817783
Name:DR JAMES PIALTOS OPTOMETRIST
Entity Type:Organization
Organization Name:DR JAMES PIALTOS OPTOMETRIST
Other - Org Name:EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PIALTOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-865-9951
Mailing Address - Street 1:103 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 CROSS ST
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-2304
Practice Address - Country:US
Practice Address - Phone:508-234-7935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20226OtherBCBS
MA9787305Medicaid
714654BOtherTUFTS
W21013Medicare ID - Type Unspecified