Healthcare Provider Details

I. General information

NPI: 1902100795
Provider Name (Legal Business Name): VISION SOURCE OF AMHERST AND GREENFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 BERNARDSTON RD SUITE 101
GREENFIELD MA
01301-1238
US

IV. Provider business mailing address

489 BERNARDSTON RD SUITE 101
GREENFIELD MA
01301-1238
US

V. Phone/Fax

Practice location:
  • Phone: 413-772-2571
  • Fax: 413-772-2266
Mailing address:
  • Phone: 413-772-2571
  • Fax: 413-772-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3258
License Number StateMA

VIII. Authorized Official

Name: DR. BRIAN WINFIELD WADMAN
Title or Position: OPTOMETRIST/PRESIDENT
Credential: O.D.
Phone: 413-772-2571