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General NPI Number Information
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NPI Number | 1265601819
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Entity Type | Organization
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Legal Business Name | MOODY OPTICAL CO. INC
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 25 W UNION ST
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City | ASHLAND
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State | MA
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Zip | 01721-1465
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Country | US
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Telephone | 508-881-4800
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Fax | 508-881-7806
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Provider Business Mailing Address
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Address Line | 25 W UNION ST
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City | ASHLAND
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State | MA
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Zip | 01721-1465
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Country | US
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Telephone | 508-881-4800
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Fax | 508-881-7806
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Authorized Official
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Title or Position | OPTICIAN
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Name | SONDA CAROL MOODY-MCCARTHY
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Credential | D.O.
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Telephone | 508-881-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1955
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License Number State | MA
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