MEDICARE: BRIGHTON EYE ASSOCIATES, 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	152W00000X	Optometrist	4178	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W20318	OTHER	MA	BCBS OF MA

General Provider Information

NPI Number	:	1790999282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTON EYE ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	372 WASHINGTON ST
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-2725
Country	:	US
Telephone Number	:	617-782-6650
Fax Number	:	617-782-2660

Provider Business Practice Location Address
First Line	:	372 WASHINGTON ST
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-2725
Country	:	US
Telephone Number	:	617-782-6650
Fax Number	:	617-782-2660

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MR. LUIS F CARVALLO
Credential	:	MBA
Telephone Number	:	617-782-6650

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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