Provider Demographics
NPI:1124280235
Name:DAVID V. REGAN, O.D., F.A.A.O. PC, INC.
Entity type:Organization
Organization Name:DAVID V. REGAN, O.D., F.A.A.O. PC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-358-4757
Mailing Address - Street 1:260 BOSTON POST RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1889
Mailing Address - Country:US
Mailing Address - Phone:508-358-4757
Mailing Address - Fax:508-358-2323
Practice Address - Street 1:260 BOSTON POST RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1889
Practice Address - Country:US
Practice Address - Phone:508-358-4757
Practice Address - Fax:508-358-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0007895Medicare PIN