=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386809978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CATARACT SURGERY CENTER OF MILFORD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2008
-----------------------------------------------------
Last Update Date | 07/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 WEST ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01757-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-381-5600
-----------------------------------------------------
Fax | 508-381-5610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 WEST ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01757-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-381-5600
-----------------------------------------------------
Fax | 508-381-5610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GLEN K. GOODMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 508-381-5600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------