Healthcare Provider Details

I. General information

NPI: 1336246941
Provider Name (Legal Business Name): EYE HEALTH VISION CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 HUTTLESTON AVE
FAIRHAVEN MA
02719-3140
US

IV. Provider business mailing address

51 STATE RD
NORTH DARTMOUTH MA
02747-3319
US

V. Phone/Fax

Practice location:
  • Phone: 508-994-2020
  • Fax: 508-991-6082
Mailing address:
  • Phone: 508-994-1400
  • Fax: 508-910-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEPHEN F SULLIVAN
Title or Position: OWNER
Credential: MD
Phone: 508-994-1400