Provider Demographics
NPI:1063892784
Name:VISION CARE BOSTON INC
Entity type:Organization
Organization Name:VISION CARE BOSTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-542-2020
Mailing Address - Street 1:48 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2301
Mailing Address - Country:US
Mailing Address - Phone:617-542-2020
Mailing Address - Fax:617-542-2021
Practice Address - Street 1:48 HIGH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2301
Practice Address - Country:US
Practice Address - Phone:617-542-2020
Practice Address - Fax:617-542-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4982152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110100941AMedicaid
MAS400185746Medicare PIN