Healthcare Provider Details

I. General information

NPI: 1730404328
Provider Name (Legal Business Name): OPHTHALMIC CONSULTANTS OF BOSTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STANIFORD ST SUITE 700
BOSTON MA
02114-2517
US

IV. Provider business mailing address

50 STANIFORD ST SUITE 700
BOSTON MA
02114-2517
US

V. Phone/Fax

Practice location:
  • Phone: 617-367-4800
  • Fax: 617-589-3905
Mailing address:
  • Phone: 617-367-4800
  • Fax: 617-589-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUZANNE MCDERMOTT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 617-314-2672