Healthcare Provider Details

I. General information

NPI: 1093726770
Provider Name (Legal Business Name): EYE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 CHURCH ST
PEMBROKE MA
02359-1950
US

IV. Provider business mailing address

1900 CROWN COLONY DRIVE SUITE 301
QUINCY MA
02169-0000
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-2308
  • Fax: 781-826-6759
Mailing address:
  • Phone: 617-770-4400
  • Fax: 617-471-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL J WASSON
Title or Position: CLERK
Credential: MD
Phone: 781-331-3300