Provider Demographics
NPI:1396755823
Name:VALLEY EYE PHYSICIANS AND SURGEONS, P.C.
Entity type:Organization
Organization Name:VALLEY EYE PHYSICIANS AND SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-772-4000
Mailing Address - Street 1:190 GROTON RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1124
Mailing Address - Country:US
Mailing Address - Phone:978-772-4000
Mailing Address - Fax:978-772-3066
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:SUITE 240
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1124
Practice Address - Country:US
Practice Address - Phone:978-772-4000
Practice Address - Fax:978-772-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9728457Medicaid
MAA34239Medicare UPIN
MAM12754Medicare ID - Type Unspecified
MAH44002Medicare UPIN
0641810001Medicare NSC
MAH14959Medicare UPIN
MA9728457Medicaid