Provider Demographics
NPI:1669650487
Name:CAMBRIDGE HEALTH ALLIANCE EYE CENTER
Entity Type:Organization
Organization Name:CAMBRIDGE HEALTH ALLIANCE EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-665-1448
Mailing Address - Street 1:65 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4324
Mailing Address - Country:US
Mailing Address - Phone:617-665-1347
Mailing Address - Fax:
Practice Address - Street 1:65 BEACON ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4324
Practice Address - Country:US
Practice Address - Phone:617-665-1347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMBRIDGE PUBLIC HEALTH/DBA/CAMBRIDGE HEALTH ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2051648Medicaid