Healthcare Provider Details

I. General information

NPI: 1861544041
Provider Name (Legal Business Name): PARRELLI OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ELM ST
DANVERS MA
01923-2835
US

IV. Provider business mailing address

35 ELM ST
DANVERS MA
01923-2835
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-0379
  • Fax:
Mailing address:
  • Phone: 978-777-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number156FX1800X
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number332H00000X
License Number StateMA

VIII. Authorized Official

Name: MR. JONATHAN PARRELLI
Title or Position: OWNER/PRESIDENT
Credential: RDO
Phone: 978-777-0379