State Street Eye Health Associates

Primary specialty

OptometristTaxonomy code 152W00000X

License

2665 Issued in MA

Legal business name

STATE STREET EYE HEALTH ASSOCIATES

Practice address

33 Broad St
Boston, MA 02109-4216

Phone

(617) 742-7200

Fax

(617) 742-7272

NPI assigned

Jun 26, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Christina Favreau

Title

Office Manager

Phone

(617) 742-7200

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689870602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 BROAD ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021094216",
            "telephone_number": "617-742-7200",
            "fax_number": "617-742-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 BROAD ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021094216",
            "telephone_number": "617-742-7200",
            "fax_number": "617-742-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE STREET EYE HEALTH ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAVREAU",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "617-742-7200",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "2665",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "2352",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0336661",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0313351",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Stasaitis, MD
• Julia Staschen
• Kara Pearson Stasko, PA-C
• Robert Staszewski, M.D.
• State Street Chiropractic, Inc
• Allison Statham, PA
• Spiro Anthony Stathas, MD
• Nikolaos Stathatos, M.D.
• Georgia Stathopoulou, PH.D.
• Jennifer A Staton, NP

• Optometrist in Boston, MA
• Providers in Boston, MA by specialty
• Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.