Provider Demographics
NPI:1376604447
Name:EYE HEALTH SERVICES,INC.
Entity Type:Organization
Organization Name:EYE HEALTH SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-770-4400
Mailing Address - Street 1:1900 CROWN COLONY DRIVE
Mailing Address - Street 2:STE 301
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0931
Mailing Address - Country:US
Mailing Address - Phone:617-770-4400
Mailing Address - Fax:617-471-5093
Practice Address - Street 1:1900 CROWN COLONY DRIVE
Practice Address - Street 2:STE 301
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0931
Practice Address - Country:US
Practice Address - Phone:617-770-4400
Practice Address - Fax:617-471-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4730156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9711317Medicaid
MAI06315Medicare UPIN
MAF61714Medicare UPIN
MAD76236Medicare UPIN
MAD93010Medicare UPIN
MA0464050002Medicare NSC
MAH57877Medicare UPIN
MAA57721Medicare UPIN
MA9711317Medicaid