Provider Demographics
NPI:1699866384
Name:ESSEX OPTICAL CORPORATION
Entity type:Organization
Organization Name:ESSEX OPTICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:978-975-3435
Mailing Address - Street 1:542 TURNPIKE STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-975-3435
Mailing Address - Fax:978-685-6641
Practice Address - Street 1:542 TURNPIKE STREET
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-975-3435
Practice Address - Fax:978-685-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1881156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1530739Medicaid
MA1530739Medicaid