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General NPI Number Information
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NPI Number | 1235368275
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Entity Type | Organization
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Legal Business Name | EJC EYECARE, LLC
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 362 MOODY ST
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City | WALTHAM
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State | MA
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Zip | 02453-5204
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Country | US
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Telephone | 781-894-0081
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Fax | 781-894-9361
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Provider Business Mailing Address
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Address Line | 362 MOODY ST
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City | WALTHAM
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State | MA
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Zip | 02453-5204
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Country | US
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Telephone | 781-894-0081
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Fax | 781-894-9361
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE ANN PARIS-WHITNEY
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Credential | O.D.
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Telephone | 781-894-0081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | MA3675
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License Number State | MA
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