Provider Demographics
NPI:1073740437
Name:DAVID FINKELSTEIN OD & RYAN SHEA OD LLC
Entity Type:Organization
Organization Name:DAVID FINKELSTEIN OD & RYAN SHEA OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-693-3517
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0519
Mailing Address - Country:US
Mailing Address - Phone:508-693-3517
Mailing Address - Fax:508-696-8570
Practice Address - Street 1:28 STATE RD.
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-0519
Practice Address - Country:US
Practice Address - Phone:508-693-3517
Practice Address - Fax:508-696-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2348332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085992AMedicaid
MAW20518OtherBLUE CROSS AND BLUE SHIELD OF MA
MAW20518OtherBLUE CROSS AND BLUE SHIELD OF MA
MA0013372Medicare PIN