Provider Demographics
NPI:1992991905
Name:SOUTH SHORE EYE CARE
Entity type:Organization
Organization Name:SOUTH SHORE EYE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:MCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-298-5300
Mailing Address - Street 1:2110 DORCHESTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5628
Mailing Address - Country:US
Mailing Address - Phone:617-298-5300
Mailing Address - Fax:617-296-3028
Practice Address - Street 1:2110 DORCHESTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5628
Practice Address - Country:US
Practice Address - Phone:617-298-5300
Practice Address - Fax:617-296-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty