Healthcare Provider Details

I. General information

NPI: 1992980478
Provider Name (Legal Business Name): BELCHERTOWN EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 N MAIN ST
BELCHERTOWN MA
01007-9433
US

IV. Provider business mailing address

PO BOX 42
BELCHERTOWN MA
01007-0042
US

V. Phone/Fax

Practice location:
  • Phone: 413-323-1196
  • Fax: 413-323-1186
Mailing address:
  • Phone: 413-323-1196
  • Fax: 413-323-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberMA4856
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberMA4856
License Number StateMA

VIII. Authorized Official

Name: MS. CHARISSA C. BROWN
Title or Position: PRESIDENT/MASTER OPTICIAN
Credential: R.D.O.
Phone: 413-323-1196