Provider Demographics
NPI:1437597424
Name:BAY STATE EXCELLENT VISION
Entity Type:Organization
Organization Name:BAY STATE EXCELLENT VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICEMANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-430-5225
Mailing Address - Street 1:155 GRIFFIN RD # 1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4125
Mailing Address - Country:US
Mailing Address - Phone:603-430-5225
Mailing Address - Fax:603-430-1230
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3919
Practice Address - Country:US
Practice Address - Phone:781-321-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty