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General NPI Number Information
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NPI Number | 1841499670
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Entity Type | Organization
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Legal Business Name | MASSACHUSETTS SOUTH EASTERN EYE CENTER, INC.
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 40 CHURCH AVE SUITE 201
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City | WAREHAM
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State | MA
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Zip | 02571-2093
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Country | US
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Telephone | 508-295-3193
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Fax | 508-295-4635
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Provider Business Mailing Address
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Address Line | 40 CHURCH ST AVENUE SUITE 201
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City | WAREHAM
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State | MA
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Zip | 02571-2093
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Country | US
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Telephone | 508-295-3193
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Fax | 508-295-4635
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | CHARLES C WHITE JR.
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Credential | M.D.
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Telephone | 508-295-3193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 53631
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number |
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License Number State | MA
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