Provider Demographics
NPI:1508451832
Name:DR SALLY CARLOS OD & ASSOCIATES
Entity type:Organization
Organization Name:DR SALLY CARLOS OD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-283-2946
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-0655
Mailing Address - Country:US
Mailing Address - Phone:413-283-2956
Mailing Address - Fax:413-283-3631
Practice Address - Street 1:1448 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1269
Practice Address - Country:US
Practice Address - Phone:413-283-2946
Practice Address - Fax:413-283-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty