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General NPI Number Information
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NPI Number | 1528128105
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Entity Type | Organization
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Legal Business Name | EYE HEALTH SERVICES,INC.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 146 CHURCH ST
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City | PEMBROKE
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State | MA
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Zip | 02359-1950
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Country | US
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Telephone | 781-826-4396
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Fax | 781-826-6759
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Provider Business Mailing Address
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Address Line | 1900 CROWN COLONY DRIVE STE 301
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City | QUINCY
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State | MA
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Zip | 02169-0931
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Country | US
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Telephone | 617-472-5242
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Fax | 617-770-2975
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Authorized Official
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Title or Position | CLERK
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Name | DR. PAUL J WASSON
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Credential | M.D.
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Telephone | 617-472-5242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4394
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License Number State | MA
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