Provider Demographics
NPI:1235312729
Name:CAROLANN SPERANZO
Entity Type:Organization
Organization Name:CAROLANN SPERANZO
Other - Org Name:SECOND SIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SPERANZO
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:617-773-1178
Mailing Address - Street 1:1147 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4343
Mailing Address - Country:US
Mailing Address - Phone:617-773-1178
Mailing Address - Fax:
Practice Address - Street 1:1147 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4343
Practice Address - Country:US
Practice Address - Phone:617-773-1178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1701332B00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1521322Medicaid
MA0188760001Medicare NSC