Provider Demographics
NPI:1578730644
Name:NORTH SUBURBAN EYE ASSOCIATES
Entity Type:Organization
Organization Name:NORTH SUBURBAN EYE ASSOCIATES
Other - Org Name:NORTH SUBURBAN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C. DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-245-5200
Mailing Address - Street 1:669 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5200
Mailing Address - Country:US
Mailing Address - Phone:781-245-3110
Mailing Address - Fax:781-246-3932
Practice Address - Street 1:699 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-245-3110
Practice Address - Fax:781-246-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier