1841242955 NPI number — SOUTHCOAST EYE CARE, INC

Table of content: (NPI 1841242955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841242955 NPI number — SOUTHCOAST EYE CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHCOAST EYE CARE, 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:
1841242955
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:
300A FAUNCE CORNER RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NORTH DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-1257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-995-8200
Provider Business Mailing Address Fax Number:
508-995-4631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300A FAUNCE CORNER RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NORTH DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-1257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-995-8200
Provider Business Practice Location Address Fax Number:
508-995-4631
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEPIN
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
508-995-8200

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 25360 . This is a "RI BCBS GROUP #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: C17344 . This is a "RR MEDICARE GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 670265 . This is a "TUFTS GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1955 . This is a "BCHIP GROUP #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2181804 . This is a "AETNA GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W20367 . This is a "OPTOMETRIST GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17235 . This is a "OPHTHALMOLOGIST BS #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 17266 . This is a "NHP GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9786007 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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