Provider Demographics
NPI:1699741173
Name:MONTACHUSETTS EYE SURGERY INC
Entity type:Organization
Organization Name:MONTACHUSETTS EYE SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-342-2137
Mailing Address - Street 1:104 WHALON ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7128
Mailing Address - Country:US
Mailing Address - Phone:978-342-2137
Mailing Address - Fax:978-343-3181
Practice Address - Street 1:104 WHALON ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7128
Practice Address - Country:US
Practice Address - Phone:978-342-2137
Practice Address - Fax:978-343-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM12407Medicare ID - Type Unspecified
MAM12407Medicare PIN