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General NPI Number Information
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NPI Number | 1790999282
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Entity Type | Organization
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Legal Business Name | BRIGHTON EYE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 372 WASHINGTON ST
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City | BRIGHTON
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State | MA
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Zip | 02135-2725
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Country | US
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Telephone | 617-782-6650
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Fax | 617-782-2660
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Provider Business Mailing Address
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Address Line | 372 WASHINGTON ST
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City | BRIGHTON
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State | MA
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Zip | 02135-2725
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Country | US
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Telephone | 617-782-6650
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Fax | 617-782-2660
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. LUIS F CARVALLO
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Credential | MBA
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Telephone | 617-782-6650
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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 | 4178
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License Number State | MA
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