1003247255 NPI number — DEDHAM OPHTHALMIC CONSULTANTS AND SURGEONS, P.C.

Table of content: (NPI 1003247255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003247255 NPI number — DEDHAM OPHTHALMIC CONSULTANTS AND SURGEONS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEDHAM OPHTHALMIC CONSULTANTS AND SURGEONS, 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:
1003247255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
980 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE120
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-6731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-251-2222
Provider Business Mailing Address Fax Number:
781-234-0279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE120
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02026-6731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-251-2222
Provider Business Practice Location Address Fax Number:
781-234-0279
Provider Enumeration Date:
12/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GILLIES
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-251-2222

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 6070110001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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