Provider Demographics
NPI:1710167101
Name:SHAWSHEEN VISION ASSOCIATES PC
Entity Type:Organization
Organization Name:SHAWSHEEN VISION ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-663-3100
Mailing Address - Street 1:1 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-1915
Mailing Address - Country:US
Mailing Address - Phone:978-663-3100
Mailing Address - Fax:
Practice Address - Street 1:1 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-1915
Practice Address - Country:US
Practice Address - Phone:978-663-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9700129Medicaid
0269610001Medicare NSC