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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ELVISI MENA (BUSINESS MANAGER)
(508) 453-8846
Entity
Organization

Contact information

Practice address
666 LINCOLN ST, WORCESTER, MA 01605-2011
(508) 453-8846
(508) 453-8832
Mailing address
666 LINCOLN ST, WORCESTER, MA 01605-2011
(508) 453-8846
(508) 453-8832

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
332H00000X
Eyewear Supplier
Primary

Other

Enumeration date
09/22/2010
Last updated
09/22/2010
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