Provider Demographics
NPI:1962638692
Name:ADVANCED EYE OPTICAL CENTERS, INC
Entity Type:Organization
Organization Name:ADVANCED EYE OPTICAL CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTAND ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLAGIOVANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-717-0266
Mailing Address - Street 1:500 FAUNCE CORNER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1278
Mailing Address - Country:US
Mailing Address - Phone:508-717-0270
Mailing Address - Fax:508-995-3060
Practice Address - Street 1:500 FAUNCE CORNER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1278
Practice Address - Country:US
Practice Address - Phone:508-717-0270
Practice Address - Fax:508-995-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5404156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty