Healthcare Provider Details

I. General information

NPI: 1225277361
Provider Name (Legal Business Name): EYE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 DORCHESTER AVE STE 100
DORCHESTER CENTER MA
02124-5628
US

IV. Provider business mailing address

1900 CROWN COLONY DR STE 301
QUINCY MA
02169-0979
US

V. Phone/Fax

Practice location:
  • Phone: 617-298-5300
  • Fax: 617-296-3028
Mailing address:
  • Phone: 617-472-5242
  • Fax: 617-770-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number6130
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PAUL J WASSON
Title or Position: CLERK
Credential: M.D.
Phone: 617-472-5242