Provider Demographics
NPI:1093221665
Name:DRIZIK EYECARE
Entity Type:Organization
Organization Name:DRIZIK EYECARE
Other - Org Name:DRIZIK EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-510-8463
Mailing Address - Street 1:2 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 SUMMER ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4529
Practice Address - Country:US
Practice Address - Phone:508-655-2594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty