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General NPI Number Information
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NPI Number | 1497080907
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Entity Type | Organization
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Legal Business Name | RETINA MACULA EYE CARE, P.C.
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 95 WASHINGTON ST SUITE 592, VILLAGE SHOPPES
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City | CANTON
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State | MA
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Zip | 02021-4006
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Country | US
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Telephone | 781-989-4744
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Fax | 781-769-4794
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Provider Business Mailing Address
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Address Line | 95 WASHINGTON ST SUITE 592, VILLAGE SHOPPES
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City | CANTON
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State | MA
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Zip | 02021-4006
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Country | US
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Telephone | 781-989-4744
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Fax | 781-769-4794
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NIGEL H. TIMOTHY
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Credential | MD
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Telephone | 617-935-5550
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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 | 220139
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License Number State | MA
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