Provider Demographics
NPI:1790958650
Name:SUBURBAN EYE SPECIALISTS PC
Entity Type:Organization
Organization Name:SUBURBAN EYE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:
Authorized Official - Last Name:DANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-769-2508
Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3441
Mailing Address - Country:US
Mailing Address - Phone:781-769-2508
Mailing Address - Fax:781-352-1099
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 160
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-769-2508
Practice Address - Fax:781-352-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52356207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A56866Medicare UPIN