Provider Demographics
NPI:1679893093
Name:VILLAGE EYE ASSOCIATES,LLC
Entity Type:Organization
Organization Name:VILLAGE EYE ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:BEJIAN
Authorized Official - Last Name:OD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-250-3937
Mailing Address - Street 1:17 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2712
Mailing Address - Country:US
Mailing Address - Phone:978-250-3937
Mailing Address - Fax:978-256-1264
Practice Address - Street 1:17 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2712
Practice Address - Country:US
Practice Address - Phone:978-250-3937
Practice Address - Fax:978-256-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3284152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110012078AMedicaid
MA0016351Medicare PIN
MAW17603Medicare PIN
MA460858Medicare PIN