Basic Information
| Provider Information | |||||||||
| NPI: | 1700268489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYES ON WORCESTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 488 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016091857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087566832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 488 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016091857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087566832 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2015 | ||||||||
| LastUpdateDate: | 06/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | SAINI | ||||||||
| AuthorizedOfficialFirstName: | NIKHIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7173184365 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4888 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.