Healthcare Provider Details

I. General information

NPI: 1962638692
Provider Name (Legal Business Name): ADVANCED EYE OPTICAL CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FAUNCE CORNER RD SUITE 110
N DARTMOUTH MA
02747-1278
US

IV. Provider business mailing address

500 FAUNCE CORNER RD SUITE 110
N DARTMOUTH MA
02747-1278
US

V. Phone/Fax

Practice location:
  • Phone: 508-717-0270
  • Fax: 508-995-3060
Mailing address:
  • Phone: 508-717-0270
  • Fax: 508-995-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number5404
License Number StateMA

VIII. Authorized Official

Name: KATHRYN S COLAGIOVANNI
Title or Position: ASSISTAND ADMINISTRATOR
Credential:
Phone: 508-717-0266