Provider Demographics
NPI:1720286008
Name:WESTBOROUGH EYECARE LLC
Entity Type:Organization
Organization Name:WESTBOROUGH EYECARE LLC
Other - Org Name:WESTBOROUGH EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-366-4500
Mailing Address - Street 1:1 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1408
Mailing Address - Country:US
Mailing Address - Phone:508-366-4500
Mailing Address - Fax:508-366-4522
Practice Address - Street 1:1 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1408
Practice Address - Country:US
Practice Address - Phone:508-366-4500
Practice Address - Fax:508-366-4522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4355152W00000X, 152WP0200X
MAMA4603152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0399990Medicaid
MAW17491Medicare ID - Type Unspecified
MA0399990Medicaid