Provider Demographics
NPI:1669593620
Name:NORTH SHORE EYE SPECIALISTS
Entity type:Organization
Organization Name:NORTH SHORE EYE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MOSER
Authorized Official - Last Name:PRENTISS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-774-7033
Mailing Address - Street 1:85 CONSTITUTION LN
Mailing Address - Street 2:SUITE 100C
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3694
Mailing Address - Country:US
Mailing Address - Phone:978-774-7033
Mailing Address - Fax:978-774-0341
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:SUITE 100C
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-774-7033
Practice Address - Fax:978-774-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0392316Medicaid
MAW20356OtherBLUE CROSS BLUE SHEILD
MA0035493OtherNEIGHBORHOOD HEALTH PLAN
MA151089OtherHARVARD PILGRIM
MA2252OtherFALLON
MA755413OtherTUFTS
MA0035493OtherNEIGHBORHOOD HEALTH PLAN
MA2252OtherFALLON
MAU54750Medicare UPIN