Provider Demographics
NPI:1518270602
Name:HOLLISTON VISION CENTER INC
Entity Type:Organization
Organization Name:HOLLISTON VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-429-1330
Mailing Address - Street 1:841 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1690
Mailing Address - Country:US
Mailing Address - Phone:508-429-1330
Mailing Address - Fax:508-429-0922
Practice Address - Street 1:841 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1690
Practice Address - Country:US
Practice Address - Phone:508-429-1330
Practice Address - Fax:508-429-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110013585AMedicaid
MA110013585AMedicaid