Provider Demographics
NPI:1013048180
Name:ATLANTIC COAST OPHTHALMOLOGY, P.C.
Entity type:Organization
Organization Name:ATLANTIC COAST OPHTHALMOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-593-3939
Mailing Address - Street 1:152 LYNNWAY
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3462
Mailing Address - Country:US
Mailing Address - Phone:781-593-3939
Mailing Address - Fax:781-593-4449
Practice Address - Street 1:152 LYNNWAY
Practice Address - Street 2:SUITE 2G
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3462
Practice Address - Country:US
Practice Address - Phone:781-593-3939
Practice Address - Fax:781-593-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78232207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2254201OtherUNITED HEALTH CARE
MA2366203OtherCIGNA
MD470104OtherTUFTS
MAAA26124OtherHARVARD PILGRIM
MA92136OtherFALLON
MA968560OtherNETWORK HEALTH
MA0036754OtherNHP
MA79258OtherUNICARE
MA9750771Medicaid
MAJ28467OtherBCBS
MA4081728OtherAETNA
MD470104OtherTUFTS