1346381563 NPI number — AUBURN VISION CENTER INC

Table of content: (NPI 1346381563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346381563 NPI number — AUBURN VISION CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUBURN VISION CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346381563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 CALVINS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01564-2213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-563-1600
Provider Business Mailing Address Fax Number:
603-954-8386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59 AUBURN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01501-2428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-832-8820
Provider Business Practice Location Address Fax Number:
508-721-5145
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LARSEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-832-8820

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  MA3972 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W201695 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W20330 . This is a "BLUE CROSS MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5393688 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 152161 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-02752 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9734490 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 973954 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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