Provider Demographics
NPI:1437533759
Name:GREATER BOSTON EYE CARE, LLC
Entity Type:Organization
Organization Name:GREATER BOSTON EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:REPPUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-633-0692
Mailing Address - Street 1:333 GREAT RIVER RD
Mailing Address - Street 2:APARTMENT 206
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1216
Mailing Address - Country:US
Mailing Address - Phone:508-633-0692
Mailing Address - Fax:
Practice Address - Street 1:739 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3207
Practice Address - Country:US
Practice Address - Phone:781-231-1097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty