1437386166 NPI number — ADVANCED EYECARE SPECIALISTS, P.C.

Table of content: (NPI 1437386166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437386166 NPI number — ADVANCED EYECARE SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED EYECARE SPECIALISTS, P.C.
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:
1437386166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 WAKEBY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSTONS MILLS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02648-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-280-2479
Provider Business Mailing Address Fax Number:
508-428-1118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02540-3175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-444-8691
Provider Business Practice Location Address Fax Number:
508-444-8693
Provider Enumeration Date:
06/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SAJBAN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
JON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-280-2479

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3456 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 3456 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0371751 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011817 . This is a "MEDICARE (PTAN)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 423858 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1942244835 . This is a "NPI- INDIVIDUAL NUMBER" identifier . This identifiers is of the category "OTHER".




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