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General NPI Number Information
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NPI Number | 1154651396
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Entity Type | Organization
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Legal Business Name | BOSTON EYELID SURGERY LLC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 873 WORCESTER ST
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City | WELLESLEY
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State | MA
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Zip | 02482-3714
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Country | US
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Telephone | 267-258-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 172 SCHOOL ST
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City | WAYLAND
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State | MA
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Zip | 01778-4524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MITESH KAPADIA
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Credential | M.D., PH.D.
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Telephone | 267-258-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 223549
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License Number State | MA
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