Provider Demographics
NPI:1447385323
Name:FAMILY OPTICIANS LTD
Entity type:Organization
Organization Name:FAMILY OPTICIANS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:INCERTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:RDO
Authorized Official - Phone:780-665-8828
Mailing Address - Street 1:490 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3841
Mailing Address - Country:US
Mailing Address - Phone:781-665-8828
Mailing Address - Fax:781-665-8828
Practice Address - Street 1:490 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3841
Practice Address - Country:US
Practice Address - Phone:781-665-8828
Practice Address - Fax:781-665-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110076265/AMedicaid
MA110076265/AMedicaid