1366434425 NPI number — WORCESTER EYE CONSULTANTS, PC

Table of content: (NPI 1366434425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366434425 NPI number — WORCESTER EYE CONSULTANTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORCESTER EYE CONSULTANTS, PC
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:
1366434425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 LANCASTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01609-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-791-8484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 LANCASTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01609-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-791-8484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZACHARIA
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
508-791-8484

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 93087 . This is a "FALLON GROUP ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 96629101 . This is a "NETWORK HEALTH GROUP ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0801744 . This is a "EVERCARE GROUP ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 637388 . This is a "TUFTS GROUP PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9763601 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: KG66 . This is a "HARVARD PIGRIM HEALTH CAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18982 . This is a "BLUE SHIELD GROUP ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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