Basic Information
| Provider Information | |||||||||
| NPI: | 1508242017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEVERLY INDEPENDENT EYE CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 ENDICOTT ST | ||||||||
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| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019235502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789215000 | ||||||||
| FaxNumber: | 9789215003 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 CABOT ST | ||||||||
| Address2: | UNIT #1 | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019152515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789215000 | ||||||||
| FaxNumber: | 9789215003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2015 | ||||||||
| LastUpdateDate: | 08/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | SEYMOUR | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9789215000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.