Provider Demographics
NPI:1851585244
Name:OPTOMETRY ASSOCIATES OF WORCESTER INC.
Entity Type:Organization
Organization Name:OPTOMETRY ASSOCIATES OF WORCESTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-756-6832
Mailing Address - Street 1:488 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1857
Mailing Address - Country:US
Mailing Address - Phone:508-756-6832
Mailing Address - Fax:508-756-5266
Practice Address - Street 1:488 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1857
Practice Address - Country:US
Practice Address - Phone:508-756-6832
Practice Address - Fax:508-756-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2398152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9702318Medicaid
MA115454Medicare PIN
MA9702318Medicaid