Organization
STATE STREET EYE HEALTH ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINA FAVREAU (OFFICE MANAGER)
(617) 742-7200
Entity
Organization
Contact information
Practice address
33 BROAD ST, BOSTON, MA 02109-4216
(617) 742-7200
(617) 742-7272
Mailing address
33 BROAD ST, BOSTON, MA 02109-4216
(617) 742-7200
(617) 742-7272
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2352
MA
152W00000X
Optometrist
Primary
2665
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0313351
—
MA
05
—
0336661
—
MA
Enumeration date
06/26/2007
Last updated
08/22/2020
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