Provider Demographics
NPI:1912006495
Name:L&D EYE ASSOCIATES
Entity Type:Organization
Organization Name:L&D EYE ASSOCIATES
Other - Org Name:BAYVIEW OPTOMETRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-477-7423
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-1410
Mailing Address - Country:US
Mailing Address - Phone:508-477-7423
Mailing Address - Fax:508-477-0584
Practice Address - Street 1:9 MARKET STREET
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:508-477-7423
Practice Address - Fax:508-477-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
533910OtherCIGNA
15750OtherHARVARD
MAW20174OtherBCBS
MA000000030006OtherBMC HEALTHNET
MA9780068Medicaid
MAU16627Medicare UPIN
1147770001Medicare NSC
MAW21018Medicare PIN