Basic Information
| Provider Information | |||||||||
| NPI: | 1063610194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MASS OPTOMETRIC ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 417821 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022417821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003400129 | ||||||||
| FaxNumber: | 2105246587 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HIGHLAND AVE | ||||||||
| Address2: | 3B | ||||||||
| City: | MALDEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021486603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813219039 | ||||||||
| FaxNumber: | 7813218611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | PEARSON | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6038988560 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.