1831381045 NPI number — COMFORT VISION INC

Table of content: (NPI 1831381045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831381045 NPI number — COMFORT VISION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORT VISION 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:
COMFORT VISION
Provider Other Organization Name Type Code:
3
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:
1831381045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
543 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-7205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-657-0205
Provider Business Mailing Address Fax Number:
617-657-0206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-7205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-657-0205
Provider Business Practice Location Address Fax Number:
617-657-0206
Provider Enumeration Date:
08/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUI
Authorized Official First Name:
TRUNG
Authorized Official Middle Name:
VAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-875-9636

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4555 , 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: 7784859 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16485 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 53944 . This is a "DAVIS VISION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA82048 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0708836 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 495705 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0708844 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132152 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3603559 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: MA4545 . This is a "EYEMED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110078170/A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W16487 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA82058 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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