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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