Provider Demographics
NPI:1801035407
Name:CHELMSFORD OPTOMETRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:CHELMSFORD OPTOMETRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ADELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-256-5731
Mailing Address - Street 1:11 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3064
Mailing Address - Country:US
Mailing Address - Phone:978-256-5731
Mailing Address - Fax:978-256-1553
Practice Address - Street 1:11 SUMMER ST
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3064
Practice Address - Country:US
Practice Address - Phone:978-256-5731
Practice Address - Fax:978-256-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0352705Medicaid
MAT89288Medicare UPIN
MA0352705Medicaid