1790962025 NPI number — RMK HOLYOKE OPTICAL INC

Table of content: (NPI 1790962025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790962025 NPI number — RMK HOLYOKE OPTICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RMK HOLYOKE OPTICAL 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:
1790962025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01040-6504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-536-7670
Provider Business Mailing Address Fax Number:
413-536-7671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 HIGH ST
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:
01040-6504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-536-7670
Provider Business Practice Location Address Fax Number:
413-536-7671
Provider Enumeration Date:
01/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KULPINSKI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-536-7670

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  4830 , 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: 0353264 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09398 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38856 . This is a "BC BS DAVIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA4830 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".