Provider Demographics
NPI:1285833848
Name:EYE HEALTH CARE OF BOURNE
Entity Type:Organization
Organization Name:EYE HEALTH CARE OF BOURNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-743-9044
Mailing Address - Street 1:1 TROWBRIDGE RD.
Mailing Address - Street 2:SUITE 333
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532
Mailing Address - Country:US
Mailing Address - Phone:508-743-9044
Mailing Address - Fax:508-743-9075
Practice Address - Street 1:1 TROWBRIDGE RD.
Practice Address - Street 2:SUITE 333
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532
Practice Address - Country:US
Practice Address - Phone:508-743-9044
Practice Address - Fax:508-743-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160748207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5452780001Medicare NSC