Provider Demographics
NPI:1093726770
Name:EYE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:EYE HEALTH SERVICES, INC
Other - Org Name:EYE HEALTH SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-331-3300
Mailing Address - Street 1:1900 CROWN COLONY DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0000
Mailing Address - Country:US
Mailing Address - Phone:617-770-4400
Mailing Address - Fax:617-471-5093
Practice Address - Street 1:146 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1950
Practice Address - Country:US
Practice Address - Phone:781-826-2308
Practice Address - Fax:781-826-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA600020OtherTUFTS HEALTH PLAN
MA449459OtherAETNA
MA9711317Medicaid
MA449459OtherAETNA