Provider Demographics
NPI:1093905085
Name:DYNAMIC EYE CARE, INC.
Entity Type:Organization
Organization Name:DYNAMIC EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-585-6883
Mailing Address - Street 1:101 INDEPENDENCE MALL WAY
Mailing Address - Street 2:C/O LENSCRAFTERS
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-3048
Mailing Address - Country:US
Mailing Address - Phone:781-585-6883
Mailing Address - Fax:
Practice Address - Street 1:101 INDEPENDENCE MALL WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-3048
Practice Address - Country:US
Practice Address - Phone:781-585-6883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW20463OtherBCBSMA
MA9785141Medicaid
MAW20463OtherBCBSMA