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General NPI Number Information
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NPI Number | 1699228445
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Entity Type | Organization
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Legal Business Name | LEXINGTON EYE ASSOCIATES-BID
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 21 WORTHEN RD
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City | LEXINGTON
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State | MA
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Zip | 02421-4835
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Country | US
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Telephone | 781-862-1620
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Fax | 781-863-9416
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Provider Business Mailing Address
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Address Line | 21 WORTHEN RD
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City | LEXINGTON
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State | MA
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Zip | 02421-4835
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Country | US
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Telephone | 781-862-1620
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Fax | 781-863-9416
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER P. MULLON
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Credential | M.D.
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Telephone | 781-862-1620
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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 |
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License Number State |
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