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Organization
RETTOC OPTICAL SERVICE
Active
Organization
RETTOC OPTICAL SERVICE
Active
Other names
Parkway Optical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JANIS M COTTER O.D. (PRESIDENT)
(781) 289-7929
Entity
Organization
Contact information
Practice address
80 BROADWAY, REVERE, MA 02151-5305
(781) 289-7929
Mailing address
80 BROADWAY, REVERE, MA 02151-5305
(781) 289-7929
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
3044
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000Q03964
BCBS/MEDEX/RETTOC
MA
01
—
000122654
BLUE CROSS/MEDEX/PARKWAY
MA
05
—
1511327
—
MA
01
—
CQ029
EMPIRE BCBS
NY
Enumeration date
09/16/2006
Last updated
09/04/2013
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