Provider Demographics
NPI:1376942094
Name:FECCOG LOWELL LLC
Entity Type:Organization
Organization Name:FECCOG LOWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAHAROZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-692-1400
Mailing Address - Street 1:5 CORNERSTONE SQ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1483
Mailing Address - Country:US
Mailing Address - Phone:978-692-1400
Mailing Address - Fax:978-692-5995
Practice Address - Street 1:5 CORNERSTONE SQ
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1483
Practice Address - Country:US
Practice Address - Phone:978-692-1400
Practice Address - Fax:978-692-5995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY EYE CARE CENTER AND OPTICAL GALLERY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-19
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty