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General NPI Number Information
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NPI Number | 1295019305
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Entity Type | Organization
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Legal Business Name | A&E OPTICAL, CORP
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 33 BERDON WAY
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City | FAIRHAVEN
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State | MA
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Zip | 02719-4643
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Country | US
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Telephone | 508-990-2020
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Fax | 508-990-2089
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Provider Business Mailing Address
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Address Line | 33 BERDON WAY
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City | FAIRHAVEN
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State | MA
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Zip | 02719-4643
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Country | US
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Telephone | 508-990-2020
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Fax | 508-990-2089
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Authorized Official
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Title or Position | MGR
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Name | IRWIN KLEIN
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Credential |
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Telephone | 508-990-2020
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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 | 5629
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License Number State | MA
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