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General NPI Number Information
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NPI Number | 1124116264
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Entity Type | Organization
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Legal Business Name | BOSTON EYE SURGERY & LASER CENTER TRUST
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 50 STANIFORD ST LOBBY LEVEL
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City | BOSTON
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State | MA
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Zip | 02114-2517
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Country | US
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Telephone | 617-723-2015
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Fax | 617-723-7787
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Provider Business Mailing Address
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Address Line | PO BOX 4175
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City | WOBURN
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State | MA
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Zip | 01888-4175
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Country | US
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Telephone | 617-723-2015
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Fax | 617-723-7787
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUZANNE MCDERMOTT
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Credential |
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Telephone | 617-314-2672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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