Provider Demographics
NPI:1184911026
Name:EYE HEALTH SERVICES, INC
Entity type:Organization
Organization Name:EYE HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EYE HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-472-5242
Mailing Address - Street 1:1900 CROWN COLONY DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0975
Mailing Address - Country:US
Mailing Address - Phone:617-770-4400
Mailing Address - Fax:617-471-5093
Practice Address - Street 1:23 WHITES PATH
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1221
Practice Address - Country:US
Practice Address - Phone:508-398-6131
Practice Address - Fax:508-398-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9711317Medicaid
MA9711317Medicaid