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General NPI Number Information
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NPI Number | 1205866910
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Entity Type | Organization
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Legal Business Name | ESSEX VITREORETINAL SERVICES, INC.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 75 HERRICK ST SUITE 215
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City | BEVERLY
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State | MA
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Zip | 01915-5903
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Country | US
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Telephone | 978-922-1390
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Fax | 978-922-1443
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Provider Business Mailing Address
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Address Line | 75 HERRICK ST SUITE 215
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City | BEVERLY
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State | MA
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Zip | 01915-5903
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Country | US
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Telephone | 978-922-1390
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Fax | 978-922-1443
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM G. STINSON
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Credential | MD
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Telephone | 978-922-1390
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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 |
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License Number State |
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