Provider Demographics
NPI:1336379510
Name:MALDEN EYECARE CLINIC LLC
Entity type:Organization
Organization Name:MALDEN EYECARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:XINSHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-512-0604
Mailing Address - Street 1:661 MAIN ST
Mailing Address - Street 2:#23
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3760
Mailing Address - Country:US
Mailing Address - Phone:617-512-0604
Mailing Address - Fax:617-418-4933
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:INSIDE WAL-MART VISION CENTER
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2735
Practice Address - Country:US
Practice Address - Phone:978-568-1036
Practice Address - Fax:978-568-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty