Provider Demographics
NPI:1619207487
Name:CHARLES RIVER EYE ASSOCIATES
Entity Type:Organization
Organization Name:CHARLES RIVER EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHALMOLOGIST/EYE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:V
Authorized Official - Last Name:GREINER
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PHD
Authorized Official - Phone:781-729-3008
Mailing Address - Street 1:5 WHITTIER PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1428
Mailing Address - Country:US
Mailing Address - Phone:781-729-3008
Mailing Address - Fax:781-729-2402
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1961
Practice Address - Country:US
Practice Address - Phone:781-729-3008
Practice Address - Fax:781-729-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56366174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588601280OtherNPI
MAM20322Medicare PIN