Provider Demographics
NPI:1316141807
Name:ADVANCE EYE CENTER, INC.
Entity type:Organization
Organization Name:ADVANCE EYE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-871-3970
Mailing Address - Street 1:22 ISABELLA ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7515
Mailing Address - Country:US
Mailing Address - Phone:781-871-3970
Mailing Address - Fax:617-471-4878
Practice Address - Street 1:22 ISABELLA ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7515
Practice Address - Country:US
Practice Address - Phone:781-871-3970
Practice Address - Fax:617-471-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty