Provider Demographics
NPI:1558717249
Name:BOSTON LASER MEDFORD LLC
Entity Type:Organization
Organization Name:BOSTON LASER MEDFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MELKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-566-0062
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 6W
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-566-0062
Mailing Address - Fax:
Practice Address - Street 1:92 HIGH ST
Practice Address - Street 2:UNIT T31
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3850
Practice Address - Country:US
Practice Address - Phone:781-396-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty