Provider Demographics
NPI:1851549166
Name:MCCARTHY, ED (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4101
Mailing Address - Country:US
Mailing Address - Phone:978-263-1968
Mailing Address - Fax:978-263-5700
Practice Address - Street 1:465 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4101
Practice Address - Country:US
Practice Address - Phone:978-263-1968
Practice Address - Fax:978-263-5700
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4123156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician