Healthcare Provider Details

I. General information

NPI: 1275111502
Provider Name (Legal Business Name): EYECARE ETC. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WARREN ST STE 1
RANDOLPH MA
02368-4015
US

IV. Provider business mailing address

9 WARREN ST STE 1
RANDOLPH MA
02368-4015
US

V. Phone/Fax

Practice location:
  • Phone: 781-963-8448
  • Fax:
Mailing address:
  • Phone: 781-963-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TARSHA WEAVER
Title or Position: VICE PRESIDENT
Credential:
Phone: 617-483-5974