Healthcare Provider Details

I. General information

NPI: 1467577759
Provider Name (Legal Business Name): SALEM EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 LAFAYETTE ST
SALEM MA
01970-4739
US

IV. Provider business mailing address

197 LAFAYETTE ST
SALEM MA
01970-4739
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-2675
  • Fax: 978-744-8982
Mailing address:
  • Phone: 978-744-2675
  • Fax: 978-744-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3114
License Number StateMA

VIII. Authorized Official

Name: DR. BRIAN T MCHUGH
Title or Position: OWNER
Credential: OD
Phone: 978-744-2675