Healthcare Provider Details

I. General information

NPI: 1285691337
Provider Name (Legal Business Name): BOSTON UNIVERSITY EYE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE # ACC-3
BOSTON MA
02118-4001
US

IV. Provider business mailing address

850 HARRISON AVE # ACC-3
BOSTON MA
02118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4020
  • Fax: 617-414-4028
Mailing address:
  • Phone: 617-414-4020
  • Fax: 617-414-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN P CHRISTIANSEN
Title or Position: CHAIRMAN
Credential: M.D., MPH
Phone: 508-823-7473