1730374927 NPI number — BRAINTREE VISION ASSOCIATES

Table of content: (NPI 1730374927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730374927 NPI number — BRAINTREE VISION ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAINTREE VISION ASSOCIATES
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:
6
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:
1730374927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 BAY STATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAINTREE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02184-5205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-848-2020
Provider Business Mailing Address Fax Number:
781-848-7230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 BAY STATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRAINTREE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02184-5205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-848-2020
Provider Business Practice Location Address Fax Number:
781-848-7230
Provider Enumeration Date:
09/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VALENTINE
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
781-848-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2613 , 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: W15300 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 151600 . This is a "HARVARD PILGRIM HEALTH PL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com