Provider Demographics
NPI:1114291994
Name:ADVANCED EYE CENTERS FR LLC
Entity Type:Organization
Organization Name:ADVANCED EYE CENTERS FR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ABRANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-717-0270
Mailing Address - Street 1:500 FAUNCE CORNER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1278
Mailing Address - Country:US
Mailing Address - Phone:508-717-0270
Mailing Address - Fax:508-995-3060
Practice Address - Street 1:1741 PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-7113
Practice Address - Country:US
Practice Address - Phone:508-674-2020
Practice Address - Fax:508-536-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9717480Medicaid
MA1740231323Medicare NSC