Provider Demographics
NPI:1093930935
Name:BURLINGTON VISION ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BURLINGTON VISION ASSOCIATES, INC.
Other - Org Name:GEORGETOWN EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRAVEIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-352-5966
Mailing Address - Street 1:1 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833-2037
Mailing Address - Country:US
Mailing Address - Phone:978-352-5966
Mailing Address - Fax:
Practice Address - Street 1:1 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833-2037
Practice Address - Country:US
Practice Address - Phone:978-352-5966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17006OtherBCBS
W20254OtherBCBS
MA0369748Medicaid
760854OtherTUFTS
1784321OtherUNITEDHEALTH
66285OtherFALLON
152293OtherHPHC
4345730001OtherDMC
MA0021531OtherNH
MAMA3790OtherMA
W17006OtherBCBS
MAU56949Medicare UPIN