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General NPI Number Information
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NPI Number | 1558475053
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Entity Type | Organization
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Legal Business Name | BAYSTATE EYE ASSOCIATES OF LEOMINSTER INC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 25 SACK BLVD
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City | LEOMINSTER
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State | MA
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Zip | 01453-3325
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Country | US
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Telephone | 978-537-2270
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Fax | 978-534-3478
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Provider Business Mailing Address
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Address Line | 25 SACK BLVD
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City | LEOMINSTER
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State | MA
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Zip | 01453-3325
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Country | US
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Telephone | 508-837-3790
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Fax | 978-534-3478
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Authorized Official
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Title or Position | OWNER
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Name | DAVID KAHAN
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Credential | OD
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Telephone | 508-837-3790
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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 | 2384
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License Number State | MA
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