Provider Demographics
NPI:1114948304
Name:TPB ENTERPRISES, INC
Entity Type:Organization
Organization Name:TPB ENTERPRISES, INC
Other - Org Name:LILLY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-875-9636
Mailing Address - Street 1:545 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5819
Mailing Address - Country:US
Mailing Address - Phone:508-875-9636
Mailing Address - Fax:508-875-3770
Practice Address - Street 1:545 UNION AVE
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5819
Practice Address - Country:US
Practice Address - Phone:508-875-9636
Practice Address - Fax:508-875-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW21101OtherMEDICARE PTAN
MA110084466/AMedicaid