Provider Demographics
NPI:1306910336
Name:WINCHESTER OPTICAL INC
Entity type:Organization
Organization Name:WINCHESTER OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-729-4553
Mailing Address - Street 1:888 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1913
Mailing Address - Country:US
Mailing Address - Phone:781-729-4553
Mailing Address - Fax:781-729-8607
Practice Address - Street 1:888 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1913
Practice Address - Country:US
Practice Address - Phone:781-729-4553
Practice Address - Fax:781-729-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0291550001Medicare ID - Type Unspecified