Provider Demographics
NPI:1073635546
Name:EYE ASSOCIATES-WORCESTER
Entity Type:Organization
Organization Name:EYE ASSOCIATES-WORCESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PIALTOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-755-6141
Mailing Address - Street 1:174 DEAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2782
Mailing Address - Country:US
Mailing Address - Phone:508-823-9307
Mailing Address - Fax:508-484-2008
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:SUITE 834
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2583
Practice Address - Country:US
Practice Address - Phone:508-755-6141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15927Medicare PIN