MEDICARE: HIGHLAND EYE CARE INC

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	4982	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184005472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND EYE CARE INC

Provider Business Mailing Address
First Line	:	33 LINCOLN ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 LINCOLN ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1526
Country	:	US
Telephone Number	:	617-332-2664
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAE HUANG
Credential	:	OD
Telephone Number	:	781-301-1436

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	07/29/2015

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