Provider Demographics
NPI:1528837309
Name:MSO DOC LLC
Entity type:Organization
Organization Name:MSO DOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VISIONARY
Authorized Official - Prefix:
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMERINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-612-5273
Mailing Address - Street 1:1150 FRIENDLY WAY S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-6119
Mailing Address - Country:US
Mailing Address - Phone:508-612-5273
Mailing Address - Fax:
Practice Address - Street 1:1077 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5247
Practice Address - Country:US
Practice Address - Phone:617-547-3310
Practice Address - Fax:617-547-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty