Basic Information
| Provider Information | |||||||||
| NPI: | 1457327728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANDAL | ||||||||
| FirstName: | EUGENIO | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET12 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088569599 | ||||||||
| FaxNumber: | 5088544998 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 NEPONSET ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088569599 | ||||||||
| FaxNumber: | 5088544998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 219237 | MA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | CHAMPUS | OTHER | 7635482 | 01 | AETNA | OTHER | J26947 | 01 | BLUE CARE ELECT | OTHER | A35980 | 01 | MEDICARE B | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 2023393 | 05 | MA | MEDICAID | AA45743 | 01 | HARVARD PILGRIM HLTHCARE | OTHER | 042472266 | 01 | TRICARE | OTHER | 3663592 | 01 | CIGNA HEALTH PLAN | OTHER | 93021 | 01 | FALLON COMM HEALTH PLAN | OTHER | 2023393 | 01 | WELFARE | OTHER | 375018 | 01 | MVP HEALTH CARE | OTHER | 7635482 | 01 | US HEALTHCARE | OTHER |