Provider Demographics
NPI:1871709139
Name:GRODEN EYE CARE, P.C.
Entity type:Organization
Organization Name:GRODEN EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRODEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:781-769-0987
Mailing Address - Street 1:13 E HOYLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3405
Mailing Address - Country:US
Mailing Address - Phone:781-769-0987
Mailing Address - Fax:781-769-0962
Practice Address - Street 1:13 E HOYLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3405
Practice Address - Country:US
Practice Address - Phone:781-769-0987
Practice Address - Fax:781-769-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42474207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2072637Medicaid
MA2072637Medicaid
MAA53858Medicare UPIN