Provider Demographics
NPI:1699233155
Name:PLYMOUTH FAMILY OPTOMETRY LLC
Entity type:Organization
Organization Name:PLYMOUTH FAMILY OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:RACETTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:774-283-4005
Mailing Address - Street 1:212 S MEADOW RD UNIT 5C
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5450
Mailing Address - Country:US
Mailing Address - Phone:774-283-4005
Mailing Address - Fax:774-374-2285
Practice Address - Street 1:212 S MEADOW RD UNIT 5C
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5450
Practice Address - Country:US
Practice Address - Phone:774-283-4005
Practice Address - Fax:774-374-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty