Provider Demographics
NPI:1144287350
Name:NORTH SHORE CATARACT AND LASER CENTER, LLC
Entity type:Organization
Organization Name:NORTH SHORE CATARACT AND LASER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-331-3820
Mailing Address - Street 1:91 MONTVALE AVE
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-438-5995
Mailing Address - Fax:781-279-1238
Practice Address - Street 1:91 MONTVALE AVE
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-438-5995
Practice Address - Fax:781-279-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
M88024OtherBCBS
MA1857975Medicaid
MA221037OtherMEDICARE PART B
694202OtherTUFTS
903499OtherHPHC
221037Medicare PIN