NPIMap

Organization Active NPI

North Suburban Eye Associates PC

  • Ophthalmology Physician
  • Wakefield, MA
National Provider Identifier
1942351994
Registry record updated Feb 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
NORTH SUBURBAN EYE ASSOCIATES PC
Practice address
669 Main St
Wakefield, MA 01880-5200
Phone
(781) 245-5200
NPI assigned
Jan 16, 2007
Last updated
Feb 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2019

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

Authorized official

Name
C. Douglas Evans, MDNPI 1982655643
Title
President
Phone
(781) 245-5200

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

669 Main St
Wakefield, MA 01880-5200

Mailing address

669 Main St
Wakefield, MA 01880-5200
Phone (781) 245-5200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051219000559 MA Part B Supplier - Clinic/Group Practice 5193747186 Receives reassigned benefits from 14 practitioners
Practice locations: Wakefield, MA; Waltham, MA; Winchester, MA

National Provider Directory

National Provider Directory
Tax ID family
North Suburban Eye Associates5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1900 Crown Colony Dr
Quincy, MA 02169
Phone (617) 472-5242

955 Main St
Ste 109
Winchester, MA 01890

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549411200000",
    "number": "1942351994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "669 MAIN ST",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018805200",
            "telephone_number": "781-245-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "669 MAIN ST",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018805200",
            "telephone_number": "781-245-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUBURBAN EYE ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2019-02-06",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "C. DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-245-5200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.