Healthcare Provider Details

I. General information

NPI: 1114238326
Provider Name (Legal Business Name): BOSTON LASER CORNEA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 HAVERHILL ST
LAWRENCE MA
01840-1208
US

IV. Provider business mailing address

1102 BEACON STREET 6W
BROOKLINE MA
02446
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-5366
  • Fax: 978-685-4867
Mailing address:
  • Phone: 617-566-0062
  • Fax: 617-734-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberMA6694
License Number StateMA

VIII. Authorized Official

Name: MS. KRISTINA SLATTERY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 617-566-0068