Provider Demographics
NPI:1750620811
Name:SUTULA EYE ASSOCIATES PC
Entity type:Organization
Organization Name:SUTULA EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUTULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-478-3600
Mailing Address - Street 1:16 ASYLUM ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2203
Mailing Address - Country:US
Mailing Address - Phone:508-478-3600
Mailing Address - Fax:508-478-5832
Practice Address - Street 1:16 ASYLUM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2203
Practice Address - Country:US
Practice Address - Phone:508-478-3600
Practice Address - Fax:508-478-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9765522Medicaid
MA716532OtherTUFTS
MAM15118OtherBLUE CROSS OF MA
MAM15118OtherBLUE CROSS OF MA