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General NPI Number Information
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NPI Number | 1669593620
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Entity Type | Organization
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Legal Business Name | NORTH SHORE EYE SPECIALISTS
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 85 CONSTITUTION LN SUITE 100C
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City | DANVERS
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State | MA
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Zip | 01923-3694
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Country | US
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Telephone | 978-774-7033
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Fax | 978-774-0341
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Provider Business Mailing Address
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Address Line | 85 CONSTITUTION LN SUITE 100C
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City | DANVERS
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State | MA
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Zip | 01923-3694
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Country | US
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Telephone | 978-774-7033
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Fax | 978-774-0341
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. WILLIAM MOSER PRENTISS
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Credential | O.D.
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Telephone | 978-774-7033
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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 | 3725
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License Number State | MA
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