Provider Demographics
NPI:1720237001
Name:OCCHIALI EYEWEAR BOUTIQUE
Entity Type:Organization
Organization Name:OCCHIALI EYEWEAR BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-799-8831
Mailing Address - Street 1:316 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1553
Mailing Address - Country:US
Mailing Address - Phone:508-799-8831
Mailing Address - Fax:508-799-8834
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1553
Practice Address - Country:US
Practice Address - Phone:508-799-8831
Practice Address - Fax:508-799-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5165156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty