Provider Demographics
NPI:1457590739
Name:WISE EYE CARE INCORPORATED
Entity Type:Organization
Organization Name:WISE EYE CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-553-9473
Mailing Address - Street 1:447 E CENTRAL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1301
Mailing Address - Country:US
Mailing Address - Phone:508-553-9473
Mailing Address - Fax:508-869-0626
Practice Address - Street 1:447 E CENTRAL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1301
Practice Address - Country:US
Practice Address - Phone:508-553-9473
Practice Address - Fax:508-869-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354155Medicaid
MAT93080Medicare UPIN