Healthcare Provider Details

I. General information

NPI: 1952460164
Provider Name (Legal Business Name): EYE HEALTH SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 LIBBEY INDUSTRIAL PKWY SUITE 100
EAST WEYMOUTH MA
02189-3110
US

IV. Provider business mailing address

1900 CROWN COLONY DRIVE STE 301
QUINCY MA
02169-0931
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-3223
  • Fax: 781-337-8356
Mailing address:
  • Phone: 617-472-5242
  • Fax: 617-770-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4067
License Number StateMA

VIII. Authorized Official

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