MEDICARE: DR. JOHN CAMMISA III O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3583	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W15914	OTHER	MA	BLUE CROSS,SHIELD,HMOBLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669592127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CAMMISA III O.D.

Provider Business Mailing Address
First Line	:	56 GRANVILLE RD
Second Line	:
City	:	SOUTHWICK
State	:	MA
Zip	:	01077-9213
Country	:	US
Telephone Number	:	413-569-5547
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 MAIN ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1224
Country	:	US
Telephone Number	:	413-737-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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