Provider Demographics
NPI:1659835528
Name:DAMYANOVA EYE ASSOCIATES
Entity Type:Organization
Organization Name:DAMYANOVA EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:PETYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMYNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-771-6097
Mailing Address - Street 1:427 LYNNWAY
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-3028
Mailing Address - Country:US
Mailing Address - Phone:781-599-2773
Mailing Address - Fax:
Practice Address - Street 1:427 LYNNWAY
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-3028
Practice Address - Country:US
Practice Address - Phone:781-598-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty