Healthcare Provider Details

I. General information

NPI: 1912956236
Provider Name (Legal Business Name): OPTOMETRIC PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 ENDICOTT ST
DANVERS MA
01923
US

IV. Provider business mailing address

2921 ERIE BLVD E OPTOMETRIC PROVIDERS INC
SYRACUSE NY
13224
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-4700
  • Fax: 978-750-0862
Mailing address:
  • Phone: 315-446-3145
  • Fax: 315-445-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALERINO M IACOBBO
Title or Position: PRESIDENT
Credential: OD
Phone: 315-446-3145