Provider Demographics
NPI:1104377621
Name:KOCH EYE ASSOCIATES,LLP
Entity Type:Organization
Organization Name:KOCH EYE ASSOCIATES,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WESTERFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-994-1400
Mailing Address - Street 1:51 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3319
Mailing Address - Country:US
Mailing Address - Phone:774-320-3040
Mailing Address - Fax:508-910-2204
Practice Address - Street 1:55 DORRANCE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-2221
Practice Address - Country:US
Practice Address - Phone:401-861-0220
Practice Address - Fax:401-861-0079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARIS VISION HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC8793OtherRAILROAD MEDICARE
RI189001069Medicare PIN
CC8793OtherRAILROAD MEDICARE