Healthcare Provider Details

I. General information

NPI: 1821426354
Provider Name (Legal Business Name): MASS OPTOMETRIC ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 CRANBERRY HWY SUITE 210
WAREHAM MA
02571-5021
US

IV. Provider business mailing address

PO BOX 29900
NEW YORK NY
10087-9907
US

V. Phone/Fax

Practice location:
  • Phone: 508-273-0107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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