Provider Demographics
NPI:1205866910
Name:ESSEX VITREORETINAL SERVICES, INC.
Entity Type:Organization
Organization Name:ESSEX VITREORETINAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-922-1390
Mailing Address - Street 1:75 HERRICK ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5903
Mailing Address - Country:US
Mailing Address - Phone:978-922-1390
Mailing Address - Fax:978-922-1443
Practice Address - Street 1:75 HERRICK ST
Practice Address - Street 2:SUITE 215
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5903
Practice Address - Country:US
Practice Address - Phone:978-922-1390
Practice Address - Fax:978-922-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21310Medicare ID - Type UnspecifiedMEDICARE GROUP #