Eye Care Provider Registration

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Thank you for your interest to join the Registry of Eye Care Providers serving people with intellectual and developmental disabilities in Massachusetts. All of the information that you provide on the form below will be used to list your practice on the Find an Eye Care Provider section of the "Focus" website.

Provide eye care at different locations in Massachusetts? Please complete the form for EACH location.
Need to UPDATE information currently posted in the Find an Eye Care Provider Registry for your practice(s)? Please complete the form for EACH location.

Questions? Please contact:

Lisa DiBonaventura, M.A., COMS

Statewide Director for Vision and Vision Loss Services

Massachusetts Department of Developmental Services (DDS)

Lisa.DiBonaventura@mass.gov

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Are you updating the current listing for your practice or submitting a new listing?

Update

New

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Name(s) of MD/OD with credentials *

Name of Practice

Address of Practice *

Phone Number of practice *

Does the practice have a website? *

Yes

If yes, please indicate website address.

Does the practice have an email address that you would like included as part of your listing? *

Yes

If yes, please indicate email address.

Office is wheelchair accessible *

Yes

Provides care for adults *

Yes

Provides care for children *

Yes

Provides care for infants *

Yes

Work with individuals who are nonverbal *

Yes

Provides longer appointment times for individuals with intellectual/developmental disabilities *

Yes

Services provided (check all that apply) *

General/Comprehensive

Emergency Eye Care

Low Vision

Optical Shop (fitting and sale of eyeglasses)

必填

Subspecialties (please indicate all)

Cataract

Cornea

Diabetic Eye Disease

Glaucoma

Neuro Ophthalmology

Ocuplastic

Pediatrics

Strabismus

Refraction

Retina

其他：

Insurance(s) accepted (please check all that apply) *

Mass Health (Medicaid)

Medicare

Private Insurance

其他：

必填

Any other information you would like to provide.

Please provide a contact email so we can contact you with any questions about your submission. The email address will NOT be posted as part of your listing on the "Focus" website. Any questions regarding your submission may come from focusvisionloss@gmail.com or Lisa.DiBonaventura@mass.gov

Thank you.

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