Provider Demographics
NPI:1457491300
Name:EYE ASSOCIATES OF SOMERVILLE INC.
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF SOMERVILLE INC.
Other - Org Name:ALAN TITELBAUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-666-1800
Mailing Address - Street 1:174 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3129
Mailing Address - Country:US
Mailing Address - Phone:617-666-1800
Mailing Address - Fax:617-628-4930
Practice Address - Street 1:174 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-3129
Practice Address - Country:US
Practice Address - Phone:617-666-1800
Practice Address - Fax:617-628-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9707310Medicaid
MAT59326Medicare UPIN
MA9707310Medicaid