Provider Demographics
NPI:1508242017
Name:BEVERLY INDEPENDENT EYE CARE, INC.
Entity Type:Organization
Organization Name:BEVERLY INDEPENDENT EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-921-5000
Mailing Address - Street 1:180 ENDICOTT ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-5502
Mailing Address - Country:US
Mailing Address - Phone:978-921-5000
Mailing Address - Fax:978-921-5003
Practice Address - Street 1:495 CABOT ST
Practice Address - Street 2:UNIT #1
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2515
Practice Address - Country:US
Practice Address - Phone:978-921-5000
Practice Address - Fax:978-921-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty