Provider Demographics
NPI:1992008346
Name:THOREN OPTICAL & SAFETY PRODUCTS, INC.
Entity Type:Organization
Organization Name:THOREN OPTICAL & SAFETY PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:413-592-1199
Mailing Address - Street 1:33 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1816
Mailing Address - Country:US
Mailing Address - Phone:413-592-1199
Mailing Address - Fax:413-592-4951
Practice Address - Street 1:33 GROVE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1816
Practice Address - Country:US
Practice Address - Phone:413-592-1199
Practice Address - Fax:413-592-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2071332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0313441Medicaid