Provider Demographics
NPI:1255839486
Name:ASSOCIATED EYE SURGEONS
Entity Type:Organization
Organization Name:ASSOCIATED EYE SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-747-4748
Mailing Address - Street 1:45 RESNIK RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4883
Mailing Address - Country:US
Mailing Address - Phone:508-747-4748
Mailing Address - Fax:508-747-0124
Practice Address - Street 1:45 RESNIK RD STE 301
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4883
Practice Address - Country:US
Practice Address - Phone:508-747-4748
Practice Address - Fax:508-747-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20126OtherMEDICARE UPIN
MA1100091270Medicaid