Provider Demographics
NPI:1548470552
Name:AMO, INC.
Entity type:Organization
Organization Name:AMO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FRANCHISE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:617-678-9726
Mailing Address - Street 1:22 MCGRATH HWY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4508
Mailing Address - Country:US
Mailing Address - Phone:617-623-7522
Mailing Address - Fax:617-696-9468
Practice Address - Street 1:22 MCGRATH HWY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4508
Practice Address - Country:US
Practice Address - Phone:617-623-7522
Practice Address - Fax:617-696-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4389156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529021Medicaid