MEDICARE: MASSACHUSETTS EYE ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912999095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSACHUSETTS EYE ASSOCIATES PC

Provider Business Mailing Address
First Line	:	19 VILLAGE SQ
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2712
Country	:	US
Telephone Number	:	978-256-5600
Fax Number	:	978-703-0250

Provider Business Practice Location Address
First Line	:	19 VILLAGE SQ
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2712
Country	:	US
Telephone Number	:	978-256-5600
Fax Number	:	978-703-0250

Authorized Official
Title or Position	:	SECRETARY/TREASURER
Name	:	DAVID H YI
Credential	:	MD
Telephone Number	:	978-256-5600

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/26/2010

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