1184783235 NPI number — HANS VONNAHME OD

Table of content: HANS VONNAHME OD (NPI 1184783235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184783235 NPI number — HANS VONNAHME OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VONNAHME
Provider First Name:
HANS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184783235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98 LOWER WESTFIELD RD
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01040-9403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-552-3937
Provider Business Mailing Address Fax Number:
413-552-3937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 LOWER WESTFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLYOKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01040-9403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-552-3937
Provider Business Practice Location Address Fax Number:
888-935-4545
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4202 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00000002205 . This is a "BMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA4204 . This is a "EYEMED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16447 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0334723 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28419 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7148370 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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