Healthcare Provider Details

I. General information

NPI: 1699233155
Provider Name (Legal Business Name): PLYMOUTH FAMILY OPTOMETRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MEADOW RD UNIT 5C
PLYMOUTH MA
02360-5450
US

IV. Provider business mailing address

212 S MEADOW RD UNIT 5C
PLYMOUTH MA
02360-5450
US

V. Phone/Fax

Practice location:
  • Phone: 774-283-4005
  • Fax: 774-374-2285
Mailing address:
  • Phone: 774-283-4005
  • Fax: 774-374-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RYAN CHRISTOPHER RACETTE
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 774-283-4005