Provider Demographics
NPI:1245781640
Name:OPHTHALMIC CONSULTANTS OF BOSTON
Entity Type:Organization
Organization Name:OPHTHALMIC CONSULTANTS OF BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-314-2672
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-4176
Mailing Address - Country:US
Mailing Address - Phone:508-833-8222
Mailing Address - Fax:508-833-9924
Practice Address - Street 1:282 ROUTE 130
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2302
Practice Address - Country:US
Practice Address - Phone:508-833-8222
Practice Address - Fax:508-833-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110067330Medicaid