Healthcare Provider Details

I. General information

NPI: 1093905085
Provider Name (Legal Business Name): DYNAMIC EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 INDEPENDENCE MALL WAY
KINGSTON MA
02364-3048
US

IV. Provider business mailing address

101 INDEPENDENCE MALL WAY C/O LENSCRAFTERS
KINGSTON MA
02364-3048
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-6883
  • Fax:
Mailing address:
  • Phone: 781-585-6883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MIEU VO
Title or Position: OWNER
Credential: OD
Phone: 781-585-6883