Provider Demographics
NPI:1922155258
Name:BASS RIVER OPTICAL, INC.
Entity Type:Organization
Organization Name:BASS RIVER OPTICAL, INC.
Other - Org Name:BASS RIVER OPTOMETRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:BAUER
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-240-0898
Mailing Address - Street 1:173 CRANBERRY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-3206
Mailing Address - Country:US
Mailing Address - Phone:508-240-0898
Mailing Address - Fax:508-240-7122
Practice Address - Street 1:173 CRANBERRY HIGHWAY
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3206
Practice Address - Country:US
Practice Address - Phone:508-240-0898
Practice Address - Fax:508-240-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA181658Medicare PIN