Provider Demographics
NPI:1023167277
Name:NEW ENGLAND VISION INC
Entity type:Organization
Organization Name:NEW ENGLAND VISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAZZARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-231-1097
Mailing Address - Street 1:739 BROADWAY
Mailing Address - Street 2:ROUTE 1 SOUTH
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3207
Mailing Address - Country:US
Mailing Address - Phone:781-231-1097
Mailing Address - Fax:781-231-1099
Practice Address - Street 1:739 BROADWAY
Practice Address - Street 2:ROUTE 1 SOUTH
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3207
Practice Address - Country:US
Practice Address - Phone:781-231-1097
Practice Address - Fax:781-231-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4717156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA102591OtherEYEMED PROVIDER NUMBER
MA18288OtherDAVIS PROVIDER NUMBER
MA0891280001Medicare ID - Type Unspecified