Provider Demographics
NPI:1659664035
Name:FAMILY EYE CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-512-7949
Mailing Address - Street 1:50 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2442
Mailing Address - Country:US
Mailing Address - Phone:617-512-7949
Mailing Address - Fax:
Practice Address - Street 1:174 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2441
Practice Address - Country:US
Practice Address - Phone:617-512-7949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIEG59603Medicaid
RI1144270398OtherINDIVIDUAL NPI
RIEG59603Medicaid
MA0023800Medicare PIN