Provider Demographics
NPI:1740469816
Name:TYNGSBORO EYE CARE, LLC
Entity type:Organization
Organization Name:TYNGSBORO EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-649-1212
Mailing Address - Street 1:150 WESTFORD RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-2511
Mailing Address - Country:US
Mailing Address - Phone:978-649-1212
Mailing Address - Fax:978-649-1218
Practice Address - Street 1:150 WESTFORD RD
Practice Address - Street 2:SUITE #4
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-2511
Practice Address - Country:US
Practice Address - Phone:978-649-1212
Practice Address - Fax:978-649-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty