Basic Information
| Provider Information | |||||||||
| NPI: | 1568546968 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISION CARE SPECIALISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 TURNPIKE RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | SOUTHBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017722115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084818558 | ||||||||
| FaxNumber: | 5088483057 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 TURNPIKE RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | SOUTHBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017722115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084818558 | ||||||||
| FaxNumber: | 5088483057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEVINE | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | ERWIN | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5084818558 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4028 | MA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 3407 | MA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152WL0500X | 4028 | MA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152WV0400X | 3407 | MA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Vision Therapy |
ID Information
| ID | Type | State | Issuer | Description | 625118 | 01 | MA | TUFTS GROUP ID NUMBER | OTHER | 0036186 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 44680 | 01 | MA | DAVIS VISION GROUP ID NUM | OTHER | W20370 | 01 | MA | BCBS GROUP ID NUMBER | OTHER |