Provider Demographics
NPI:1750453510
Name:NATICK EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:NATICK EYE ASSOCIATES, PC
Other - Org Name:BURLINGTON OPTOMETRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-655-8127
Mailing Address - Street 1:1364 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1514
Mailing Address - Country:US
Mailing Address - Phone:508-655-8127
Mailing Address - Fax:508-652-0819
Practice Address - Street 1:1364 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1514
Practice Address - Country:US
Practice Address - Phone:508-655-8127
Practice Address - Fax:508-652-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW20102OtherBLUECROSS BLULD SHIELD
MA428458Medicare ID - Type Unspecified