Provider Demographics
NPI:1588905343
Name:MASSACHUSETTS EYE RESEARCH AND SURGERY INSTITUTION
Entity type:Organization
Organization Name:MASSACHUSETTS EYE RESEARCH AND SURGERY INSTITUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FERIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TADIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-891-6377
Mailing Address - Street 1:1440 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1631
Mailing Address - Country:US
Mailing Address - Phone:781-891-6377
Mailing Address - Fax:781-647-1430
Practice Address - Street 1:5 CAMBRIDGE CTR
Practice Address - Street 2:8TH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1407
Practice Address - Country:US
Practice Address - Phone:617-621-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110070707AMedicaid