Healthcare Provider Details

I. General information

NPI: 1063749307
Provider Name (Legal Business Name): BOSTON LASER EYE INSTITUTE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 10/17/2021
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 WEBSTER PL
BROOKLINE MA
02445-7937
US

IV. Provider business mailing address

24 WEBSTER PL
BROOKLINE MA
02445-7937
US

V. Phone/Fax

Practice location:
  • Phone: 617-202-2020
  • Fax: 617-735-9616
Mailing address:
  • Phone: 617-202-2020
  • Fax: 617-735-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number4R1G
License Number StateMA

VIII. Authorized Official

Name: SAMIR MELKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 617-566-0062