1720158652 NPI number — D'AMBROSIO EYE CARE, INC.

Table of content: (NPI 1720158652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720158652 NPI number — D'AMBROSIO EYE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D'AMBROSIO EYE CARE, 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:
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:
1720158652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
479 OLD UNION TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01523-3029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-537-3900
Provider Business Mailing Address Fax Number:
978-537-6030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDNER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01440-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-632-3930
Provider Business Practice Location Address Fax Number:
978-632-3158
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
D'AMBROSIO
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-537-3900

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9762582 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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