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General NPI Number Information
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NPI Number | 1679228738
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Entity Type | Organization
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Legal Business Name | BOSTON VISION NETWORK ONE
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 02/22/2024
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Provider Practice Location 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 | 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 | 617-202-2020
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SAMIR A MELKI
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Credential | MD
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Telephone | 617-202-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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