Healthcare Provider Details

I. General information

NPI: 1841499670
Provider Name (Legal Business Name): MASSACHUSETTS SOUTH EASTERN EYE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CHURCH AVE SUITE 201
WAREHAM MA
02571-2093
US

IV. Provider business mailing address

40 CHURCH ST AVENUE SUITE 201
WAREHAM MA
02571-2093
US

V. Phone/Fax

Practice location:
  • Phone: 508-295-3193
  • Fax: 508-295-4635
Mailing address:
  • Phone: 508-295-3193
  • Fax: 508-295-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number53631
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number StateMA

VIII. Authorized Official

Name: CHARLES C WHITE JR.
Title or Position: OPHTHALMOLOGIST
Credential: M.D.
Phone: 508-295-3193