1689701096 NPI number — BOSTON EYE CARE CONSULTANTS

Table of content: (NPI 1689701096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689701096 NPI number — BOSTON EYE CARE CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON EYE CARE CONSULTANTS
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:
1689701096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 4-5
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-771-6447
Provider Business Mailing Address Fax Number:
508-775-5104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 4-5
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-771-6447
Provider Business Practice Location Address Fax Number:
508-775-5104
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LYTLE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-771-6447

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2579 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 54395 , 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: 1063440881 . This is a "JANET LEMOINE NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 15376 . This is a "PILGRIM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1831185099 . This is a "LYTLE NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 711397 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0393762 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AETNA . This is a "4090239" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M14824 . This is a "BCBS GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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