Healthcare Provider Details

I. General information

NPI: 1295467272
Provider Name (Legal Business Name): SERENITY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ARSENAL ST
WATERTOWN MA
02472-2853
US

IV. Provider business mailing address

23 WEBSTER RD
LEXINGTON MA
02421-8227
US

V. Phone/Fax

Practice location:
  • Phone: 617-744-3150
  • Fax:
Mailing address:
  • Phone: 646-239-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: HONG JI
Title or Position: DOCTOR
Credential: OD/PHD
Phone: 646-239-4219