Basic Information
| Provider Information | |||||||||
| NPI: | 1689864845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MASS OPTOMETRIC ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2921 ERIE BLVD E | ||||||||
| Address2: | C/O EMPIRE VISION CENTER, INC | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132241430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154463145 | ||||||||
| FaxNumber: | 3154457675 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HIGHLAND AVE | ||||||||
| Address2: | #3B TOWN LINE PLAZA | ||||||||
| City: | MALDEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021486603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813219039 | ||||||||
| FaxNumber: | 7813218611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 07/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | PEARSON | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7813219039 | ||||||||
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| 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 | MA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.