1316982325 NPI number — ANNE J FARLEY-POYANT OD

Table of content: ANNE J FARLEY-POYANT OD (NPI 1316982325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316982325 NPI number — ANNE J FARLEY-POYANT OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARLEY-POYANT
Provider First Name:
ANNE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARLEY
Provider Other First Name:
ANNE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316982325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 STANIFORD STREET
Provider Second Line Business Mailing Address:
SUITE 600 OPTHALMIC CONSULTANTS OF BOSTON
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-367-4800
Provider Business Mailing Address Fax Number:
617-589-3905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 ANSEL HALLET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST YARMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02673-2556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-771-4848
Provider Business Practice Location Address Fax Number:
508-833-9924
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3871 , 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: 003871 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110017665A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 157757 . This is a "HARVARD PILGRIM HLTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: W16104 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0369942 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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