Provider Demographics
NPI:1558436105
Name:CATARACT LASER CENTERCENTRAL LLC
Entity Type:Organization
Organization Name:CATARACT LASER CENTERCENTRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-632-6674
Mailing Address - Street 1:95 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3119
Mailing Address - Country:US
Mailing Address - Phone:978-632-6674
Mailing Address - Fax:978-632-5798
Practice Address - Street 1:95 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3119
Practice Address - Country:US
Practice Address - Phone:978-632-6674
Practice Address - Fax:978-632-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QS0132X261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1850237Medicaid
MA1850237Medicaid