1528077989 NPI number — EYE HEALTH SERVICES, INC.

Table of content: (NPI 1528077989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528077989 NPI number — EYE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE HEALTH SERVICES, 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:
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:
1528077989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 CROWN COLONY DRIVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-770-4400
Provider Business Mailing Address Fax Number:
617-471-5093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 CROWN COLONY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-770-4400
Provider Business Practice Location Address Fax Number:
617-471-5093
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WASSON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CLERK
Authorized Official Telephone Number:
617-770-4400

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: 9711317 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600020 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 449459 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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