Provider Demographics
NPI:1265635783
Name:LUDLOW EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:LUDLOW EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DAVILLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-583-3600
Mailing Address - Street 1:200 CENTER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2772
Mailing Address - Country:US
Mailing Address - Phone:413-583-3600
Mailing Address - Fax:413-589-0783
Practice Address - Street 1:200 CENTER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2772
Practice Address - Country:US
Practice Address - Phone:413-583-3600
Practice Address - Fax:413-589-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3056152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0186430001Medicare NSC