Basic Information
| Provider Information | |||||||||
| NPI: | 1902911563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR EYE HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE PEARL STREET | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085842100 | ||||||||
| FaxNumber: | 5085846633 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE PEARL STREET | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085842100 | ||||||||
| FaxNumber: | 5085846633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RUBIN | ||||||||
| AuthorizedOfficialFirstName: | HERBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OPHTHALMOLOGIST/PRESIDENT OF GROUP | ||||||||
| AuthorizedOfficialTelephone: | 5086763411 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 9772693 | 05 | MA | MEDICAID | M15445 | 01 | MA | BCBS | OTHER |