Organization
BOUCHER'S OPTICIANS OF BROCKTON, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY MARSHALL FOOTE REGISTERED DISPENSIN (OWNER/PRESIDENT)
(508) 586-2725
Entity
Organization
Contact information
Practice address
727 BELMONT STREET, BROCKTON, MA 02301-5666
(508) 586-2725
(508) 586-2770
Mailing address
727 BELMONT STREET, BROCKTON, MA 02301-5666
(508) 586-2725
(508) 586-2770
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1615
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03306908387
MASSHEALTH TRADING PARTNE
MA
01
—
1506773
MASSHEALTH PROVIDER
MA
Enumeration date
03/27/2008
Last updated
09/24/2008
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