Provider Demographics
NPI:1588678551
Name:ANDOVER EYE ASSOCIATES, INC
Entity Type:Organization
Organization Name:ANDOVER EYE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-475-0705
Mailing Address - Street 1:138 HAVERHILL ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1509
Mailing Address - Country:US
Mailing Address - Phone:978-475-0705
Mailing Address - Fax:978-475-0008
Practice Address - Street 1:138 HAVERHILL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1509
Practice Address - Country:US
Practice Address - Phone:978-475-0705
Practice Address - Fax:978-475-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACN0909OtherRAILROAD MEDICARE
706615OtherTUFTS
MA9731555Medicaid
MA9731555Medicaid
MAM12680Medicare ID - Type Unspecified