Provider Demographics
NPI:1265601819
Name:MOODY OPTICAL CO. INC
Entity type:Organization
Organization Name:MOODY OPTICAL CO. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SONDA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:MOODY-MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:508-881-4800
Mailing Address - Street 1:25 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1465
Mailing Address - Country:US
Mailing Address - Phone:508-881-4800
Mailing Address - Fax:508-881-7806
Practice Address - Street 1:25 W UNION ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-1465
Practice Address - Country:US
Practice Address - Phone:508-881-4800
Practice Address - Fax:508-881-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1955332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1599062Medicaid
MA1599062Medicaid