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General NPI Number Information
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NPI Number | 1437597424
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Entity Type | Organization
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Legal Business Name | BAY STATE EXCELLENT VISION
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 600 MAIN ST
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City | MALDEN
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State | MA
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Zip | 02148-3919
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Country | US
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Telephone | 781-321-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 155 GRIFFIN RD # 1
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4125
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Country | US
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Telephone | 603-430-5225
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Fax | 603-430-1230
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Authorized Official
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Title or Position | OFFICEMANAGER
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Name | MR. BRIAN D MOSER
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Credential |
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Telephone | 603-430-5225
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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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