Healthcare Provider Details

I. General information

NPI: 1699709691
Provider Name (Legal Business Name): PEDIATRIC OPHTHALMIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 CONCORD ST
FRAMINGHAM MA
01702-8305
US

IV. Provider business mailing address

PO BOX 270
FRAMINGHAM MA
01704-0270
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-3204
  • Fax: 508-620-0098
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD BLOCKER
Title or Position: OPHTHALMOLOGIST
Credential:
Phone: 508-879-3204