Provider Demographics
NPI:1750375713
Name:NORTH SHORE OPHTHALMIC ASSOCIATES INC
Entity type:Organization
Organization Name:NORTH SHORE OPHTHALMIC ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-744-1900
Mailing Address - Street 1:79 HIGHLAND AVE
Mailing Address - Street 2:SALEM HOSPITAL MEDICAL OFFICE BUILDING SUITE 101
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2711
Mailing Address - Country:US
Mailing Address - Phone:978-744-1900
Mailing Address - Fax:978-744-3333
Practice Address - Street 1:79 HIGHLAND AVE
Practice Address - Street 2:SALEM HOSPITAL MEDICAL OFFICE BUILDING SUITE 101
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2711
Practice Address - Country:US
Practice Address - Phone:978-744-1900
Practice Address - Fax:978-744-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9705082Medicaid
M13784Medicare ID - Type Unspecified
MA9705082Medicaid