Provider Demographics
NPI:1699026369
Name:IRIS BROWN EYE CARE, LLC
Entity type:Organization
Organization Name:IRIS BROWN EYE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-848-4481
Mailing Address - Street 1:250 GRANITE ST
Mailing Address - Street 2:SUITE 2111
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2804
Mailing Address - Country:US
Mailing Address - Phone:781-848-4481
Mailing Address - Fax:781-848-4484
Practice Address - Street 1:250 GRANITE ST
Practice Address - Street 2:SUITE 2111
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2804
Practice Address - Country:US
Practice Address - Phone:781-848-4481
Practice Address - Fax:781-848-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3657332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier