Provider Demographics
NPI:1962422741
Name:NEWTON WELLESLEY EYE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:NEWTON WELLESLEY EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:N
Authorized Official - Last Name:CARMODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-964-1050
Mailing Address - Street 1:60 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2151
Mailing Address - Country:US
Mailing Address - Phone:617-964-1050
Mailing Address - Fax:617-964-6449
Practice Address - Street 1:60 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2151
Practice Address - Country:US
Practice Address - Phone:617-964-1050
Practice Address - Fax:617-964-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9730761Medicaid
MAM12710OtherBCBS GROUP NUMBER
MA762173OtherTUFTS GROUP NUMBER
MA=========OtherUH GROUP NUMBER
MA=========OtherHP GROUP NUMBER
MA9730761Medicaid