1588905343 NPI number — MASSACHUSETTS EYE RESEARCH AND SURGERY INSTITUTION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588905343 NPI number — MASSACHUSETTS EYE RESEARCH AND SURGERY INSTITUTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSACHUSETTS EYE RESEARCH AND SURGERY INSTITUTION
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:
1588905343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1440 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-891-6377
Provider Business Mailing Address Fax Number:
781-647-1430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 CAMBRIDGE CTR
Provider Second Line Business Practice Location Address:
8TH FLOOR
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02142-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-621-6377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TADIC
Authorized Official First Name:
FERIDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
781-891-6377

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: 110070707A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com