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General NPI Number Information
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NPI Number | 1639447329
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Entity Type | Organization
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Legal Business Name | TWIN CITY EYE, INC.
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 22 MCGRATH HWY # 4 PEARLE VISION
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City | SOMERVILLE
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State | MA
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Zip | 02143-4508
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Country | US
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Telephone | 617-625-3400
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Fax | 617-623-1326
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Provider Business Mailing Address
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Address Line | 59 WEST ST
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City | NEWTON
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State | MA
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Zip | 02458-1349
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Country | US
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Telephone | 617-285-4575
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Fax | 617-623-1326
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEX RUSSAKOVSKY
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Credential | O.D.
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Telephone | 617-285-4575
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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 | 4635
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License Number State | MA
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