Healthcare Provider Details

I. General information

NPI: 1508242017
Provider Name (Legal Business Name): BEVERLY INDEPENDENT EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 CABOT ST UNIT #1
BEVERLY MA
01915-2515
US

IV. Provider business mailing address

180 ENDICOTT ST
DANVERS MA
01923-5502
US

V. Phone/Fax

Practice location:
  • Phone: 978-921-5000
  • Fax: 978-921-5003
Mailing address:
  • Phone: 978-921-5000
  • Fax: 978-921-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY L SEYMOUR
Title or Position: DIRECTOR
Credential: O.D.
Phone: 978-921-5000