Provider Demographics
NPI:1043385412
Name:PERSONAL EYES INC
Entity Type:Organization
Organization Name:PERSONAL EYES INC
Other - Org Name:MARVIN HERTZEL PRES
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-963-2333
Mailing Address - Street 1:1157 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1157 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2135
Practice Address - Country:US
Practice Address - Phone:781-963-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
885521OtherTUFTS
W20255OtherBCBS
MA9720821Medicaid
MAW21042Medicare PIN
MA9720821Medicaid