Provider Demographics
NPI:1790862183
Name:CATARACT AND LASER CENTER OF THE NORTH SHORE, LLC
Entity type:Organization
Organization Name:CATARACT AND LASER CENTER OF THE NORTH SHORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ NURSE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-475-0959
Mailing Address - Street 1:349 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2687
Mailing Address - Country:US
Mailing Address - Phone:978-475-0959
Mailing Address - Fax:978-475-1769
Practice Address - Street 1:349 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2687
Practice Address - Country:US
Practice Address - Phone:978-475-0959
Practice Address - Fax:978-475-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1850253Medicaid