Healthcare Provider Details

I. General information

NPI: 1750620811
Provider Name (Legal Business Name): SUTULA EYE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ASYLUM ST
MILFORD MA
01757-2203
US

IV. Provider business mailing address

16 ASYLUM ST
MILFORD MA
01757-2203
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-3600
  • Fax: 508-478-5832
Mailing address:
  • Phone: 508-478-3600
  • Fax: 508-478-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: FRANCIS C SUTULA
Title or Position: PRESIDENT
Credential: MD
Phone: 508-478-3600