1811393341 NPI number — OPHTHALMIC CONSULTANTS OF BOSTON, INC,

Table of content: (NPI 1811393341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811393341 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:
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:
1811393341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 ENDICOTT ST STE 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVERS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01923-3623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-524-0050
Provider Business Mailing Address Fax Number:
978-524-0051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 ENDICOTT ST STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVERS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01923-3623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-524-0050
Provider Business Practice Location Address Fax Number:
978-524-0051
Provider Enumeration Date:
11/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HERLIHY
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
617-367-4800

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




Copyright © 2007-2025 www.npivalidator.com