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General NPI Number Information
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NPI Number | 1629370622
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Entity Type | Organization
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Legal Business Name | WATCH CITY OPTICAL
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 20 HOPE AVE
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City | WALTHAM
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State | MA
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Zip | 02453-2721
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Country | US
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Telephone | 781-894-3800
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Fax | 781-891-7936
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Provider Business Mailing Address
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Address Line | 20 HOPE AVE
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City | WALTHAM
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State | MA
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Zip | 02453-2721
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Country | US
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Telephone | 781-894-3800
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Fax | 781-891-7936
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANA COHEN
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Credential | OPTICIAN
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Telephone | 781-894-3800
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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 | 1750
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License Number State | MA
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