Healthcare Provider Details

I. General information

NPI: 1326135013
Provider Name (Legal Business Name): ESSEX OPTICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ENON ST
BEVERLY MA
01915-1168
US

IV. Provider business mailing address

40 ENON ST
BEVERLY MA
01915-1168
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-5996
  • Fax: 978-922-5997
Mailing address:
  • Phone: 978-922-5996
  • Fax: 978-922-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number1881
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1881
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1881
License Number StateMA

VIII. Authorized Official

Name: MR. JEFFREY STEWART BIRD
Title or Position: PRESIDENT
Credential: RDO
Phone: 978-922-5996