Organization
SOUTHCOAST OPTICAL SHOP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J HORAN (OPTICIAN)
(508) 995-1963
Entity
Organization
Contact information
Practice address
300A FAUNCE CORNER RD, SUITE 101, NORTH DARTMOUTH, MA 02747-1257
(508) 995-1963
(508) 995-6808
Mailing address
300A FAUNCE CORNER RD, SUITE 101, NORTH DARTMOUTH, MA 02747-1257
(508) 995-1963
(508) 995-6808
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
124350
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
616948
TUFTS # OPTICAL SHOP
MA
05
—
9732390
—
MA
01
—
Q04198
MA/BC DME
MA
Enumeration date
05/17/2006
Last updated
08/22/2020
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