Provider Demographics
NPI:1679228738
Name:BOSTON VISION NETWORK ONE
Entity Type:Organization
Organization Name:BOSTON VISION NETWORK ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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 1:24 WEBSTER PL
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7937
Practice Address - Country:US
Practice Address - Phone:617-202-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty