Provider Demographics
NPI:1508609041
Name:PERCEPTION OPTICAL LLC
Entity type:Organization
Organization Name:PERCEPTION OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTAPA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO, NCLE
Authorized Official - Phone:781-316-0141
Mailing Address - Street 1:60 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8621
Mailing Address - Country:US
Mailing Address - Phone:781-316-0141
Mailing Address - Fax:
Practice Address - Street 1:60 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8621
Practice Address - Country:US
Practice Address - Phone:781-316-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier