=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851579114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVARD & MOSKOS EYE HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2008
-----------------------------------------------------
Last Update Date | 02/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 W GROVE ST SUITE 101
-----------------------------------------------------
City | MIDDLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02346-1458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-947-7321
-----------------------------------------------------
Fax | 508-947-0086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 W GROVE ST SUITE 101
-----------------------------------------------------
City | MIDDLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02346-1458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-947-7321
-----------------------------------------------------
Fax | 508-947-0086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATING MANAGER
-----------------------------------------------------
Name | DR. GERALD ERNEST SAVARD
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 508-947-7321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2318
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------