Provider Demographics
NPI:1902817687
Name:EYE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:EYE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EYE HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-472-5242
Mailing Address - Street 1:1900 CROWN COLONY DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0931
Mailing Address - Country:US
Mailing Address - Phone:617-472-5242
Mailing Address - Fax:617-770-2975
Practice Address - Street 1:1900 CROWN COLONY DR
Practice Address - Street 2:SUITE 301
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0931
Practice Address - Country:US
Practice Address - Phone:617-472-5242
Practice Address - Fax:617-770-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9711317Medicaid
MA93797OtherAETNA
MA600020OtherTUFTS HEALTH PLAN
MAW21065Medicare ID - Type Unspecified