Healthcare Provider Details

I. General information

NPI: 1851585244
Provider Name (Legal Business Name): OPTOMETRY ASSOCIATES OF WORCESTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 PLEASANT ST
WORCESTER MA
01609-1857
US

IV. Provider business mailing address

488 PLEASANT ST
WORCESTER MA
01609-1857
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-6832
  • Fax: 508-756-5266
Mailing address:
  • Phone: 508-756-6832
  • Fax: 508-756-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2398
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9702318
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: DR. RICHARD ALAN GROSSMAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 508-756-6832