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General NPI Number Information
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NPI Number | 1194275230
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Entity Type | Organization
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Legal Business Name | WEST SUBURBAN EYE SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 321 BILLERICA RD
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City | CHELMSFORD
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State | MA
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Zip | 01824-4169
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Country | US
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Telephone | 978-614-0510
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Fax | 781-891-9305
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Provider Business Mailing Address
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Address Line | 321 BILLERICA RD
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City | CHELMSFORD
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State | MA
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Zip | 01824-4169
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Country | US
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Telephone | 978-614-0510
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Fax | 978-614-0511
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. EVAN GOLD
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Credential | M.D.
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Telephone | 781-891-9300
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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 | AIIY
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License Number State | MA
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