1568546968 NPI number — VISION CARE SPECIALISTS, P.C.

Table of content: (NPI 1568546968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568546968 NPI number — VISION CARE SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION CARE SPECIALISTS, P.C.
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:
1568546968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 TURNPIKE RD
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
SOUTHBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01772-2115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-481-8558
Provider Business Mailing Address Fax Number:
508-848-3057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 TURNPIKE RD
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
SOUTHBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01772-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-481-8558
Provider Business Practice Location Address Fax Number:
508-848-3057
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
ERWIN
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
508-481-8558

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4028 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152W00000X , with the licence number: 3407 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WL0500X , with the licence number: 4028 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WV0400X , with the licence number: 3407 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 625118 . This is a "TUFTS GROUP ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0036186 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 44680 . This is a "DAVIS VISION GROUP ID NUM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W20370 . This is a "BCBS GROUP ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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