Provider Demographics
NPI:1528476785
Name:EYECUITY
Entity type:Organization
Organization Name:EYECUITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LODESPOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-446-4700
Mailing Address - Street 1:87 METACOMET ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9795
Mailing Address - Country:US
Mailing Address - Phone:631-446-4700
Mailing Address - Fax:
Practice Address - Street 1:87 METACOMET ST
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9795
Practice Address - Country:US
Practice Address - Phone:631-446-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2571932085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty