Provider Demographics
NPI:1346648136
Name:MICROSURGICAL EYE CONSULTANTS
Entity Type:Organization
Organization Name:MICROSURGICAL EYE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-531-4400
Mailing Address - Street 1:31 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7901
Mailing Address - Country:US
Mailing Address - Phone:978-531-4400
Mailing Address - Fax:978-531-7106
Practice Address - Street 1:31 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7901
Practice Address - Country:US
Practice Address - Phone:978-531-4400
Practice Address - Fax:978-531-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM14459Medicare UPIN