Healthcare Provider Details

I. General information

NPI: 1588472393
Provider Name (Legal Business Name): BOSTON VISION NETWORK ONE - HALLMARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN ST
MEDFORD MA
02155-4540
US

IV. Provider business mailing address

24 WEBSTER PL
BROOKLINE MA
02445-7937
US

V. Phone/Fax

Practice location:
  • Phone: 617-202-2020
  • Fax:
Mailing address:
  • Phone: 603-769-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMIR MELKI
Title or Position: OWNER
Credential: MD
Phone: 617-818-7075