Provider Demographics
NPI:1033213269
Name:CAPE COD EYE SURGERY & LASER CENTER, LLC
Entity Type:Organization
Organization Name:CAPE COD EYE SURGERY & LASER CENTER, LLC
Other - Org Name:CAPE COD EYE SURGERY & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERLINY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-314-2672
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563
Mailing Address - Country:US
Mailing Address - Phone:508-833-8222
Mailing Address - Fax:
Practice Address - Street 1:282 ROUTE 130
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:508-833-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM88016OtherBLUE CROSS
MA1857860Medicaid
MA1857860Medicaid