Organization
MED RAC'S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN ALTON EDCO (CEO)
(781) 733-3809
Entity
Organization
Contact information
Practice address
300 CONGRESS STREET, SUITE 201, QUINCY, MA 02169
(781) 733-3809
(617) 471-7041
Mailing address
300 CONGRESS STREET, SUITE 201, QUINCY, MA 02169
(781) 733-3809
(617) 471-7041
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
78177
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9705554
—
MA
Enumeration date
12/29/2011
Last updated
12/29/2011
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