Provider Demographics
NPI:1821875279
Name:LUMEN VISION CARE
Entity Type:Organization
Organization Name:LUMEN VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGRZYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-257-1516
Mailing Address - Street 1:95 WASHINGTON ST STE 466
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4008
Mailing Address - Country:US
Mailing Address - Phone:508-257-1516
Mailing Address - Fax:
Practice Address - Street 1:95 WASHINGTON ST STE 466
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4008
Practice Address - Country:US
Practice Address - Phone:781-462-1719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty