Provider Demographics
NPI:1003900382
Name:FAMILY EYE CARE CENTER & OPTICAL GALLERY INC.
Entity Type:Organization
Organization Name:FAMILY EYE CARE CENTER & OPTICAL GALLERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAHAROZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-692-1400
Mailing Address - Street 1:5 CORNERSTONE SQUARE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3198
Mailing Address - Country:US
Mailing Address - Phone:978-692-1400
Mailing Address - Fax:978-692-5995
Practice Address - Street 1:5 CORNERSTONE SQUARE
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3198
Practice Address - Country:US
Practice Address - Phone:978-692-1400
Practice Address - Fax:978-692-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA740025OtherTUFTS
MA9775137Medicaid
MAM16086OtherBC/BS
MA150559OtherHARVARD PILGRIM HEALTH CA
MA23648OtherFALLON
MAM16086Medicare ID - Type Unspecified