Healthcare Provider Details

I. General information

NPI: 1346648136
Provider Name (Legal Business Name): MICROSURGICAL EYE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CENTENNIAL DR
PEABODY MA
01960-7901
US

IV. Provider business mailing address

31 CENTENNIAL DR
PEABODY MA
01960-7901
US

V. Phone/Fax

Practice location:
  • Phone: 978-531-4400
  • Fax: 978-531-7106
Mailing address:
  • Phone: 978-531-4400
  • Fax: 978-531-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNNE LUSTER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 978-531-4400