Provider Demographics
NPI:1245843937
Name:NORTH SHORE RETINA PLLC
Entity type:Organization
Organization Name:NORTH SHORE RETINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHROKH
Authorized Official - Middle Name:C
Authorized Official - Last Name:KHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-922-1344
Mailing Address - Street 1:47 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1032
Mailing Address - Country:US
Mailing Address - Phone:978-922-1344
Mailing Address - Fax:978-922-1346
Practice Address - Street 1:900 CUMMINGS CTR STE 308V
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6181
Practice Address - Country:US
Practice Address - Phone:978-922-1344
Practice Address - Fax:978-922-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty