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General NPI Number Information
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NPI Number | 1558561753
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Entity Type | Organization
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Legal Business Name | MASS OPTOMETRIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 1168 MASSACHUSETTS AVE HARVARD SQUARE
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5205
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Country | US
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Telephone | 617-547-6080
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Fax | 617-576-9223
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Provider Business Mailing Address
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Address Line | 175 E HOUSTON ST
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2299
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Country | US
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Telephone | 800-340-0219
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Fax | 210-524-6587
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | DOLSIE MCDONALD
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Credential |
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Telephone | 726-444-4078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | MA
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