Provider Demographics
NPI:1790574739
Name:RETINA SPECIALISTS OF BOSTON AND WELLESLEY LLC
Entity type:Organization
Organization Name:RETINA SPECIALISTS OF BOSTON AND WELLESLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:BAUMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-256-7684
Mailing Address - Street 1:PO BOX 620026
Mailing Address - Street 2:
Mailing Address - City:NEWTON LOWER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02462-0026
Mailing Address - Country:US
Mailing Address - Phone:617-256-7684
Mailing Address - Fax:
Practice Address - Street 1:326 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2702
Practice Address - Country:US
Practice Address - Phone:617-256-7684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty