Provider Demographics
NPI:1235290867
Name:EYE HEALTH SERVICES,INC.
Entity Type:Organization
Organization Name:EYE HEALTH SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-472-5242
Mailing Address - Street 1:1900 CROWN COLONY DRIVE
Mailing Address - Street 2:STE 301
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0931
Mailing Address - Country:US
Mailing Address - Phone:617-472-5242
Mailing Address - Fax:617-770-2975
Practice Address - Street 1:21 BRISTOL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1199
Practice Address - Country:US
Practice Address - Phone:508-565-3450
Practice Address - Fax:508-565-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5617156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9711317Medicaid
MA9711317Medicaid
MAB74367Medicare UPIN
MAH57877Medicare UPIN
MAD87950Medicare UPIN
MAB76317Medicare UPIN
MA0464050004Medicare NSC