Provider Demographics
NPI:1679531610
Name:BOSTON UNIVERSITY EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BOSTON UNIVERSITY EYE ASSOCIATES, INC.
Other - Org Name:BOSTON UNIVERSITY EYE ASSOCIATES SURGERY & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:508-823-7473
Mailing Address - Street 1:90 NEW STATE HWY
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1433
Mailing Address - Country:US
Mailing Address - Phone:508-823-7473
Mailing Address - Fax:508-880-3616
Practice Address - Street 1:90 NEW STATE HWY
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1433
Practice Address - Country:US
Practice Address - Phone:508-823-7473
Practice Address - Fax:508-880-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0528749OtherAETNA
MAM88004OtherBCBS MA
RI411515OtherBCBS (BLUECHIP)
MA6801002OtherUNITED HEALTHCARE
MA615277OtherTUFTS HEALTH PLAN
MA68-00180OtherEVERCARE
MA6801002OtherUNITED HEALTHCARE