Provider Demographics
NPI:1740231323
Name:ADVANCED EYE CENTERS INC
Entity Type:Organization
Organization Name:ADVANCED EYE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-717-0270
Mailing Address - Street 1:500 FAUNCE CORNER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1278
Mailing Address - Country:US
Mailing Address - Phone:508-717-0270
Mailing Address - Fax:508-995-3060
Practice Address - Street 1:500 FAUNCE CORNER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1278
Practice Address - Country:US
Practice Address - Phone:508-717-0270
Practice Address - Fax:508-995-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9717480Medicaid
MA4953520001Medicare NSC
MA9717480Medicaid