Healthcare Provider Details

I. General information

NPI: 1003002155
Provider Name (Legal Business Name): HARVARD SQUARE EYE CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DUNSTER ST
CAMBRIDGE MA
02138-5002
US

IV. Provider business mailing address

19 DUNSTER ST
CAMBRIDGE MA
02138-5002
US

V. Phone/Fax

Practice location:
  • Phone: 617-354-5590
  • Fax:
Mailing address:
  • Phone: 617-354-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4211
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number4211
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number4211
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number4211
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number6165
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4211
License Number StateMA

VIII. Authorized Official

Name: DR. LAUREN DICKERMAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 61733545590