Provider Demographics
NPI:1225180797
Name:EYE SERVICES CONSULTANTS INC PC
Entity Type:Organization
Organization Name:EYE SERVICES CONSULTANTS INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-296-1828
Mailing Address - Street 1:PO BOX 365481
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136
Mailing Address - Country:US
Mailing Address - Phone:617-296-1828
Mailing Address - Fax:617-298-0854
Practice Address - Street 1:2110 DORCHESTER AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5628
Practice Address - Country:US
Practice Address - Phone:617-296-1828
Practice Address - Fax:617-296-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA056584207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3071413Medicaid
MA3071413Medicaid
E50461Medicare UPIN