Provider Demographics
NPI:1598850869
Name:EAVES, RALPH W (OD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:W
Last Name:EAVES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FORDS CROSSING
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-659-1853
Mailing Address - Fax:
Practice Address - Street 1:1422 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339
Practice Address - Country:US
Practice Address - Phone:781-826-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15640OtherBC/BS OF MA
MA0352632Medicaid
MAT91495Medicare UPIN
42855801Medicare PIN