Provider Demographics
NPI:1770679045
Name:CHILDRENS HOSPITAL OPHTHALMOLOGY FOUNDATION INC
Entity Type:Organization
Organization Name:CHILDRENS HOSPITAL OPHTHALMOLOGY FOUNDATION INC
Other - Org Name:PEDIATRIC OPHTHALMOLOGY SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-355-6405
Mailing Address - Street 1:300 LONGWOOD AVENUE
Mailing Address - Street 2:FEGAN 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-6405
Mailing Address - Fax:617-730-0305
Practice Address - Street 1:300 LONGWOOD AVENUE
Practice Address - Street 2:FEGAN 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-6401
Practice Address - Fax:617-730-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty