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Organization
EYE CENTER OF THE NORTH SHORE, LLC
Active
Organization
EYE CENTER OF THE NORTH SHORE, LLC
Active
Other names
Eye Center Optical
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL PATKIN MD (PRESIDENT)
(978) 744-1177
Entity
Organization
Contact information
Practice address
400 HIGHLAND AVE, SUITE 20, SALEM, MA 01970-7003
(978) 744-1177
(978) 910-0507
Mailing address
400 HIGHLAND AVE, SUITE 20, SALEM, MA 01970-7003
(978) 744-1177
(978) 910-0507
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015503
MEDICARE PTAN
MA
05
—
110087149A
—
MA
Enumeration date
11/03/2010
Last updated
06/09/2011
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