Provider Demographics
NPI:1821161704
Name:D'AMBROSIO EYE CARE, INC.
Entity Type:Organization
Organization Name:D'AMBROSIO EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'AMBROSIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:978-537-3900
Mailing Address - Street 1:479 OLD UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-3029
Mailing Address - Country:US
Mailing Address - Phone:978-537-3900
Mailing Address - Fax:978-537-6030
Practice Address - Street 1:74 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2634
Practice Address - Country:US
Practice Address - Phone:978-632-3930
Practice Address - Fax:978-632-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA433858Medicare ID - Type Unspecified