MEDICARE: SOUTH SHORE EYE CARE, P.C.

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	207W00000X	Ophthalmology Physician	077904	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	:	1528103900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SHORE EYE CARE, P.C.

Provider Business Mailing Address
First Line	:	2110 DORCHESTER AVE
Second Line	:	SUITE 100
City	:	BOSTON
State	:	MA
Zip	:	02124-5628
Country	:	US
Telephone Number	:	617-298-5300
Fax Number	:	617-296-3028

Provider Business Practice Location Address
First Line	:	2110 DORCHESTER AVE
Second Line	:	SUITE 100
City	:	BOSTON
State	:	MA
Zip	:	02124-5628
Country	:	US
Telephone Number	:	617-298-5300
Fax Number	:	617-296-3028

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARY LISA MCHAM
Credential	:	M.D.
Telephone Number	:	617-298-5300

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	04/01/2010

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Directions to “SOUTH SHORE EYE CARE, P.C. ” Practice Location

Language	Start Address	Practice Location

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