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General NPI Number Information
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NPI Number | 1588472393
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Entity Type | Organization
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Legal Business Name | BOSTON VISION NETWORK ONE - HALLMARK LLC
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 101 MAIN ST
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City | MEDFORD
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State | MA
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Zip | 02155-4540
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Country | US
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Telephone | 617-202-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 24 WEBSTER PL
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City | BROOKLINE
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State | MA
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Zip | 02445-7937
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Country | US
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Telephone | 603-769-9340
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMIR MELKI
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Credential | MD
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Telephone | 617-818-7075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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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 | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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License Number |
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License Number State |
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