Provider Demographics
NPI:1952460164
Name:EYE HEALTH SERVICES,INC.
Entity Type:Organization
Organization Name:EYE HEALTH SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-472-5242
Mailing Address - Street 1:1900 CROWN COLONY DRIVE
Mailing Address - Street 2:STE 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 1:97 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3110
Practice Address - Country:US
Practice Address - Phone:781-331-3223
Practice Address - Fax:781-337-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
MA4067332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9711317Medicaid
MAF61714Medicare UPIN
MAA40120Medicare UPIN
MAB74367Medicare UPIN
MAB97328Medicare UPIN
MAD93010Medicare UPIN
MA9711317Medicaid
MAB76317Medicare UPIN
MAA57721Medicare UPIN
MAB76084Medicare UPIN
MAD67727Medicare UPIN
MAH57877Medicare UPIN
MA0464050003Medicare NSC
MAI06315Medicare UPIN