Provider Demographics
NPI:1982783676
Name:REDSTONE EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:REDSTONE EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONSIRISERMSOOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-438-3372
Mailing Address - Street 1:75 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3305
Mailing Address - Country:US
Mailing Address - Phone:781-438-3372
Mailing Address - Fax:781-438-3050
Practice Address - Street 1:75 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3305
Practice Address - Country:US
Practice Address - Phone:781-438-3372
Practice Address - Fax:781-438-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7734753OtherAETNA PROVIDER NUMBER
MAAA29247OtherHARVARD PILGRIM
MAW20386OtherBLUE CROSS BLUE SHIELD
MAMA4307OtherEYE MED VISION CARE
MAW20386OtherBLUE CROSS BLUE SHIELD
MAAA29247OtherHARVARD PILGRIM