Provider Demographics
NPI:1447349840
Name:VISIONARY EYE CARE LLC
Entity type:Organization
Organization Name:VISIONARY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YELEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-537-0202
Mailing Address - Street 1:875 MERRIAM AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1236
Mailing Address - Country:US
Mailing Address - Phone:978-537-0202
Mailing Address - Fax:978-537-0303
Practice Address - Street 1:875 MERRIAM AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1236
Practice Address - Country:US
Practice Address - Phone:978-537-0202
Practice Address - Fax:978-537-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3744152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9750151Medicaid
MAW21081Medicare PIN