Provider Demographics
NPI:1629712526
Name:BOSTON VISION NETWORK ONE-LAWRENCE LLC
Entity Type:Organization
Organization Name:BOSTON VISION NETWORK ONE-LAWRENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SENADA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-202-2020
Mailing Address - Street 1:24 WEBSTER PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7937
Mailing Address - Country:US
Mailing Address - Phone:617-202-2020
Mailing Address - Fax:
Practice Address - Street 1:25 MARSTON ST APT 104
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2356
Practice Address - Country:US
Practice Address - Phone:978-685-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty