Provider Demographics
NPI:1790999282
Name:BRIGHTON EYE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BRIGHTON EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:617-782-6650
Mailing Address - Street 1:372 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2725
Mailing Address - Country:US
Mailing Address - Phone:617-782-6650
Mailing Address - Fax:617-782-2660
Practice Address - Street 1:372 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2725
Practice Address - Country:US
Practice Address - Phone:617-782-6650
Practice Address - Fax:617-782-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW20318OtherBCBS OF MA
MAW21058Medicare ID - Type Unspecified