MEDICARE: SOUTH SHORE EYE ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2384	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0034244	OTHER		AETNA-U S HEALTHCARE
2	W20019	OTHER	MA	HMO BLUE

General Provider Information

NPI Number	:	1083735351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SHORE EYE ASSOCIATES PC

Provider Business Mailing Address
First Line	:	670 DEPOT ST
Second Line	:	PO BOX 1100
City	:	EASTON
State	:	MA
Zip	:	02334-9800
Country	:	US
Telephone Number	:	508-238-8460
Fax Number	:	508-238-8468

Provider Business Practice Location Address
First Line	:	670 DEPOT ST
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-2742
Country	:	US
Telephone Number	:	508-238-8460
Fax Number	:	508-238-8468

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES H FREEDMAN
Credential	:	OD
Telephone Number	:	508-238-8460

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/13/2010

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