Healthcare Provider Details

I. General information

NPI: 1205313525
Provider Name (Legal Business Name): BOSTON EYE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BEACON ST STE 6W
BROOKLINE MA
02446-5587
US

IV. Provider business mailing address

1101 BEACON ST STE 6W
BROOKLINE MA
02446-5587
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-0062
  • Fax: 617-734-3264
Mailing address:
  • Phone: 617-566-0062
  • Fax: 617-734-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SAMIR MELKI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 617-566-0062