Provider Demographics
NPI:1952535726
Name:RETINA SPECIALISTS OF BOSTON, INC.
Entity Type:Organization
Organization Name:RETINA SPECIALISTS OF BOSTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIDIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-864-6350
Mailing Address - Street 1:2285 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1260
Mailing Address - Country:US
Mailing Address - Phone:617-864-6350
Mailing Address - Fax:617-864-6437
Practice Address - Street 1:2285 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1260
Practice Address - Country:US
Practice Address - Phone:617-864-6350
Practice Address - Fax:617-864-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty