1568125086 NPI number — WESTERN MASS EYE CARE INC

Table of content: (NPI 1568125086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568125086 NPI number — WESTERN MASS EYE CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MASS EYE CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1568125086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 CAMELOT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01085-5406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-537-1056
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 COURT ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01085-3552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-264-0600
Provider Business Practice Location Address Fax Number:
413-264-0302
Provider Enumeration Date:
10/21/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOLTENBREY
Authorized Official First Name:
AMY
Authorized Official Middle Name:
CAMEROTA
Authorized Official Title or Position:
OPTOMETRIST/PRESIDENT
Authorized Official Telephone Number:
413-537-1056

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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