Provider Demographics
NPI:1336559921
Name:SAUGUS EYE GROUP, INC.
Entity Type:Organization
Organization Name:SAUGUS EYE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSAKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-285-4575
Mailing Address - Street 1:22 MCGRATH HWY # 4
Mailing Address - Street 2:PEARLE VISION
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4508
Mailing Address - Country:US
Mailing Address - Phone:617-285-4575
Mailing Address - Fax:
Practice Address - Street 1:739 BROADWAY
Practice Address - Street 2:PEARLE VISION
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty