MEDICARE: GRODEN EYE CARE 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	207W00000X	Ophthalmology Physician	42474	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	601393	OTHER	MA	TUFTS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C21043	OTHER	MA	BLUE SHIELD

General Provider Information

NPI Number	:	1962408278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRODEN EYE CARE PC

Provider Business Mailing Address
First Line	:	13 E HOYLE ST
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-3405
Country	:	US
Telephone Number	:	781-769-0987
Fax Number	:	781-769-0962

Provider Business Practice Location Address
First Line	:	13 E HOYLE ST
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-3405
Country	:	US
Telephone Number	:	781-769-0987
Fax Number	:	781-769-0962

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	JOSEPH M GRODEN
Credential	:	MD
Telephone Number	:	781-769-0987

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/20/2015

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Directions to “GRODEN EYE CARE PC ” Practice Location

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