Provider Demographics
NPI:1952571812
Name:ACK EYE, PC
Entity Type:Organization
Organization Name:ACK EYE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-228-0844
Mailing Address - Street 1:13 OLD SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-6065
Mailing Address - Country:US
Mailing Address - Phone:508-228-0844
Mailing Address - Fax:508-228-0491
Practice Address - Street 1:13 OLD SOUTH RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-6065
Practice Address - Country:US
Practice Address - Phone:508-228-0844
Practice Address - Fax:508-228-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOP-3832-TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W1719602Medicare UPIN
6182700001Medicare NSC