1730404328 NPI number — OPHTHALMIC CONSULTANTS OF BOSTON, INC.

Table of content: (NPI 1730404328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730404328 NPI number — OPHTHALMIC CONSULTANTS OF BOSTON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHTHALMIC CONSULTANTS OF BOSTON, 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:
1730404328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 STANIFORD ST
Provider Second Line Business Mailing Address:
SUITE 700
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:
50 STANIFORD ST
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-367-4800
Provider Business Practice Location Address Fax Number:
617-589-3905
Provider Enumeration Date:
04/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCDERMOTT
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
617-314-2672

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: 110067330C , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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