Provider Demographics
NPI:1558413096
Name:INDEPENDENCE EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:INDEPENDENCE EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIELTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MD
Authorized Official - Phone:508-985-6600
Mailing Address - Street 1:365 FAUNCE CORNER RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-6230
Mailing Address - Country:US
Mailing Address - Phone:508-985-6600
Mailing Address - Fax:
Practice Address - Street 1:365 FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1252
Practice Address - Country:US
Practice Address - Phone:508-951-2397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157456207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6055590001Medicare NSC