Healthcare Provider Details

I. General information

NPI: 1871774174
Provider Name (Legal Business Name): SURGICAL EYE EXPERTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 GROVE ST
WORCESTER MA
01605-3924
US

IV. Provider business mailing address

385 GROVE ST
WORCESTER MA
01605-3924
US

V. Phone/Fax

Practice location:
  • Phone: 508-453-8820
  • Fax: 508-791-4151
Mailing address:
  • Phone: 508-453-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BRADLEY DAINES
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 508-852-0600