Provider Demographics
NPI:1407039100
Name:EMIL HOROWITZ, O.D., PC
Entity Type:Organization
Organization Name:EMIL HOROWITZ, O.D., PC
Other - Org Name:MASS BAY EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-327-2200
Mailing Address - Street 1:1530 VFW PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-5500
Mailing Address - Country:US
Mailing Address - Phone:617-327-2200
Mailing Address - Fax:617-327-3700
Practice Address - Street 1:1530 VFW PKWY
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-5500
Practice Address - Country:US
Practice Address - Phone:617-327-2200
Practice Address - Fax:617-327-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0334545Medicaid
MA0490270001Medicare NSC
MA0334545Medicaid