Healthcare Provider Details

I. General information

NPI: 1417543034
Provider Name (Legal Business Name): PLANEYE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 MARKET DR
ATHOL MA
01331-9829
US

IV. Provider business mailing address

184 MARKET DR
ATHOL MA
01331-9829
US

V. Phone/Fax

Practice location:
  • Phone: 978-939-3128
  • Fax: 978-650-2090
Mailing address:
  • Phone: 978-939-3128
  • Fax: 978-650-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY J KENNIFF
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 978-939-3128