Provider Demographics
NPI:1720117765
Name:THE OPTICAL HOUSE, INC
Entity Type:Organization
Organization Name:THE OPTICAL HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANGONE
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:781-245-7263
Mailing Address - Street 1:333 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2300
Mailing Address - Country:US
Mailing Address - Phone:781-245-7263
Mailing Address - Fax:
Practice Address - Street 1:333 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2300
Practice Address - Country:US
Practice Address - Phone:781-245-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 13448332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA801248OtherTUFTS MEDICARE PREFERRED
MA801248OtherTUFTS MEDICARE PREFERRED