Healthcare Provider Details

I. General information

NPI: 1346312170
Provider Name (Legal Business Name): ESSEX OPTICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RAILROAD AVENUE
GLOUCESTER MA
01915
US

IV. Provider business mailing address

29 RAILROAD AVENUE
GLOUCESTER MA
01915
US

V. Phone/Fax

Practice location:
  • Phone: 978-281-4514
  • Fax: 978-281-4668
Mailing address:
  • Phone:
  • Fax: 978-281-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JEFFREY STEWART BIRD
Title or Position: PRESIDENT
Credential: RDO
Phone: 978-281-4514