NPIMap

Organization Active NPI

Eye Center of the North Shore, LLC

  • Eyewear Supplier
  • Salem, MA
National Provider Identifier
1609177948
Registry record updated Jun 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
EYE CENTER OF THE NORTH SHORE, LLC
Practice address
400 Highland Ave
Suite 20
Salem, MA 01970-7003
Phone
(978) 744-1177
Fax
(978) 910-0507
NPI assigned
Nov 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randall Patkin, MDNPI 1366447864
Title
President
Phone
(978) 744-1177

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X MA Primary

Addresses

Primary practice location

400 Highland Ave
Suite 20
Salem, MA 01970-7003

Mailing address

400 Highland Ave
Suite 20
Salem, MA 01970-7003
Phone (978) 744-1177

Other identifiers 2

IdentifierTypeStateIssuer
110087149AMedicaidMA
0015503OtherMAMEDICARE PTAN

Other names 1

  • Eye Center Optical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110407000908 MA DME Supplier - Physician - OptometristDME Supplier - Optician 2264561174 Practice locations: Salem, MA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eye Center of the North Shore, LLC400 Highland Ave, Salem, MA 01970-1783(978) 744-1177 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 2014

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307577600000",
    "number": "1609177948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HIGHLAND AVE",
            "address_2": "SUITE 20",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019707003",
            "telephone_number": "978-744-1177",
            "fax_number": "978-910-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HIGHLAND AVE",
            "address_2": "SUITE 20",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019707003",
            "telephone_number": "978-744-1177",
            "fax_number": "978-910-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CENTER OF THE NORTH SHORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-03",
        "last_updated": "2011-06-09",
        "status": "A",
        "authorized_official_last_name": "PATKIN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-744-1177",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110087149A",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0015503",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Center Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.