Provider Demographics
NPI:1124426937
Name:DR ARNOLD ZIDE
Entity type:Organization
Organization Name:DR ARNOLD ZIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZIDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-542-2015
Mailing Address - Street 1:48 HIGH ST
Mailing Address - Street 2:VISIONCARE2000
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2301
Mailing Address - Country:US
Mailing Address - Phone:617-542-2015
Mailing Address - Fax:617-542-2021
Practice Address - Street 1:48 HIGH ST
Practice Address - Street 2:VISIONCARE2000
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2301
Practice Address - Country:US
Practice Address - Phone:617-542-2015
Practice Address - Fax:617-542-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2670TP152WC0802X, 152WS0006X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110014734/AMedicaid