Provider Demographics
NPI:1922552157
Name:D&M OPTICAL & HEARING AID CORP
Entity Type:Organization
Organization Name:D&M OPTICAL & HEARING AID CORP
Other - Org Name:GORAL COMMUNITY OPTICIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-791-9291
Mailing Address - Street 1:38 SOUTHBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2019
Mailing Address - Country:US
Mailing Address - Phone:508-791-9291
Mailing Address - Fax:508-791-9292
Practice Address - Street 1:38 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2019
Practice Address - Country:US
Practice Address - Phone:508-791-9291
Practice Address - Fax:508-791-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5269156FC0800X, 156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty