Provider Demographics
NPI:1043410244
Name:MASS OPTOMETRIC ASSOCIATES, PLLC
Entity type:Organization
Organization Name:MASS OPTOMETRIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-815-1646
Mailing Address - Street 1:175 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2299
Mailing Address - Country:US
Mailing Address - Phone:800-340-0219
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:1623 BEACON ST
Practice Address - Street 2:WASHINGTON SQUARE
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4531
Practice Address - Country:US
Practice Address - Phone:617-739-2707
Practice Address - Fax:617-730-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty