Healthcare Provider Details

I. General information

NPI: 1437386166
Provider Name (Legal Business Name): ADVANCED EYECARE SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 MAIN ST
FALMOUTH MA
02540-3175
US

IV. Provider business mailing address

619 WAKEBY RD
MARSTONS MILLS MA
02648-1623
US

V. Phone/Fax

Practice location:
  • Phone: 508-444-8691
  • Fax: 508-444-8693
Mailing address:
  • Phone: 508-280-2479
  • Fax: 508-428-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3456
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3456
License Number StateMA

VIII. Authorized Official

Name: DR. TIMOTHY JON SAJBAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 508-280-2479