Provider Demographics
NPI:1679062335
Name:CODMAN EYE CARE AFFILIATES -SOUTH SHORE INC
Entity Type:Organization
Organization Name:CODMAN EYE CARE AFFILIATES -SOUTH SHORE INC
Other - Org Name:CODMAN EYE CARE AFFILIATES SOUTH SHORE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-963-8448
Mailing Address - Street 1:637 WASHINGTON STREET
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3510
Mailing Address - Country:US
Mailing Address - Phone:617-825-9660
Mailing Address - Fax:617-288-7898
Practice Address - Street 1:9 WARREN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-963-8448
Practice Address - Fax:781-963-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty