Provider Demographics
NPI:1437386166
Name:ADVANCED EYECARE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:ADVANCED EYECARE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:SAJBAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-280-2479
Mailing Address - Street 1:619 WAKEBY RD
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1623
Mailing Address - Country:US
Mailing Address - Phone:508-280-2479
Mailing Address - Fax:508-428-1118
Practice Address - Street 1:352 MAIN ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3175
Practice Address - Country:US
Practice Address - Phone:508-444-8691
Practice Address - Fax:508-444-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-21
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3456152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0371751Medicaid
MA0011817OtherMEDICARE (PTAN)
MA423858OtherMEDICARE ID-TYPE UNSPECIFIED
1942244835OtherNPI- INDIVIDUAL NUMBER
1942244835OtherNPI- INDIVIDUAL NUMBER
T88024Medicare UPIN