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General NPI Number Information
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NPI Number | 1326135013
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Entity Type | Organization
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Legal Business Name | ESSEX OPTICAL CORPORATION
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 40 ENON ST
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City | BEVERLY
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State | MA
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Zip | 01915-1168
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Country | US
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Telephone | 978-922-5996
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Fax | 978-922-5997
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Provider Business Mailing Address
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Address Line | 40 ENON ST
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City | BEVERLY
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State | MA
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Zip | 01915-1168
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Country | US
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Telephone | 978-922-5996
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Fax | 978-922-5997
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY STEWART BIRD
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Credential | RDO
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Telephone | 978-922-5996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | 1881
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1881
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1881
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License Number State | MA
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