Provider Demographics
NPI:1699228445
Name:LEXINGTON EYE ASSOCIATES-BID
Entity Type:Organization
Organization Name:LEXINGTON EYE ASSOCIATES-BID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:P
Authorized Official - Last Name:MULLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-862-1620
Mailing Address - Street 1:21 WORTHEN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4835
Mailing Address - Country:US
Mailing Address - Phone:781-862-1620
Mailing Address - Fax:781-863-9416
Practice Address - Street 1:21 WORTHEN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4835
Practice Address - Country:US
Practice Address - Phone:781-862-1620
Practice Address - Fax:781-863-9416
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON EYE ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS100198299OtherMEDICARE