MEDICARE: PRATTVILLE EYE ASSOCIATES, LLC

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	2889	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005905	OTHER	MA	MEDICARE PTAN

General Provider Information

NPI Number	:	1386854776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRATTVILLE EYE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	200 WALNUT ST
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-1158
Country	:	US
Telephone Number	:	781-231-1100
Fax Number	:	781-231-9634

Provider Business Practice Location Address
First Line	:	200 WALNUT ST
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-1158
Country	:	US
Telephone Number	:	781-231-1100
Fax Number	:	781-231-9634

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ROBERT ARNOLD BUONFIGLIO
Credential	:	O.D.
Telephone Number	:	781-231-1100

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	09/23/2008

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