Healthcare Provider Details

I. General information

NPI: 1154854941
Provider Name (Legal Business Name): MASS OPTOMETRIC ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 RUSSELL ST UNIT 5
HADLEY MA
01035-5904
US

IV. Provider business mailing address

175 E HOUSTON ST
SAN ANTONIO TX
78205-2299
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-0452
  • Fax: 413-584-0382
Mailing address:
  • Phone: 800-340-0129
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: RANDI FRANKL
Title or Position: PRESIDENT
Credential: OD
Phone: 516-815-1646