Provider Demographics
NPI:1417543034
Name:PLANEYE, LLC
Entity Type:Organization
Organization Name:PLANEYE, LLC
Other - Org Name:THE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENNIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-939-3128
Mailing Address - Street 1:184 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-9829
Mailing Address - Country:US
Mailing Address - Phone:978-939-3128
Mailing Address - Fax:978-650-2090
Practice Address - Street 1:184 MARKET DR
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-9829
Practice Address - Country:US
Practice Address - Phone:978-939-3128
Practice Address - Fax:978-650-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA23165Medicaid