Provider Demographics
NPI:1811393341
Name:OPHTHALMIC CONSULTANTS OF BOSTON, INC,
Entity Type:Organization
Organization Name:OPHTHALMIC CONSULTANTS OF BOSTON, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HERLIHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-367-4800
Mailing Address - Street 1:104 ENDICOTT ST STE 303
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3623
Mailing Address - Country:US
Mailing Address - Phone:978-524-0050
Mailing Address - Fax:978-524-0051
Practice Address - Street 1:104 ENDICOTT ST STE 303
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3623
Practice Address - Country:US
Practice Address - Phone:978-524-0050
Practice Address - Fax:978-524-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110067330LMedicaid
MA110067330GMedicaid