Healthcare Provider Details

I. General information

NPI: 1144287350
Provider Name (Legal Business Name): NORTH SHORE CATARACT AND LASER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MONTVALE AVE
STONEHAM MA
02180
US

IV. Provider business mailing address

91 MONTVALE AVE
STONEHAM MA
02180
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-5995
  • Fax: 781-279-1238
Mailing address:
  • Phone: 781-438-5995
  • Fax: 781-279-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH J CAMEROTA
Title or Position: ADMINISTRATOR
Credential:
Phone: 781-331-3820