Provider Demographics
NPI:1114238326
Name:BOSTON LASER CORNEA CENTER
Entity Type:Organization
Organization Name:BOSTON LASER CORNEA CENTER
Other - Org Name:BOSTON EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-566-0068
Mailing Address - Street 1:1102 BEACON STREET
Mailing Address - Street 2:6W
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-566-0062
Mailing Address - Fax:617-734-3264
Practice Address - Street 1:280 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1208
Practice Address - Country:US
Practice Address - Phone:978-685-5366
Practice Address - Fax:978-685-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA6694152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6016050001Medicare NSC