Provider Demographics
NPI:1881954550
Name:ACUVISION EYECARE CENTER, INC
Entity type:Organization
Organization Name:ACUVISION EYECARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER-HOWAYECK
Authorized Official - Suffix:
Authorized Official - Credentials:O,D
Authorized Official - Phone:508-999-4401
Mailing Address - Street 1:16 FAIRHAVEN COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4627
Mailing Address - Country:US
Mailing Address - Phone:508-999-4401
Mailing Address - Fax:508-992-3937
Practice Address - Street 1:16 FAIRHAVEN COMMONS WAY
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4627
Practice Address - Country:US
Practice Address - Phone:508-999-4401
Practice Address - Fax:508-992-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3515152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0334740Medicaid
MA0324051Medicaid
MA0334740Medicaid
MAW17265Medicare PIN
MAU76520Medicare UPIN
MA431758Medicare PIN