Provider Demographics
NPI:1710053699
Name:BOSTON EYEWEAR
Entity Type:Organization
Organization Name:BOSTON EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KALISH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:781-784-3089
Mailing Address - Street 1:18 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1825
Mailing Address - Country:US
Mailing Address - Phone:718-784-3089
Mailing Address - Fax:
Practice Address - Street 1:700 COMMONWEALTH AVE UPPR FLOOR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2496
Practice Address - Country:US
Practice Address - Phone:617-536-0899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty