Healthcare Provider Details

I. General information

NPI: 1033244330
Provider Name (Legal Business Name): OPTICAL STUDIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 PLEASANT ST
NORTHAMPTON MA
01060-3953
US

IV. Provider business mailing address

274 PLEASANT ST
NORTHAMPTON MA
01060-3953
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-6616
  • Fax:
Mailing address:
  • Phone: 413-584-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MARIBETH A ERB
Title or Position: OWNER OPTOMETRIST
Credential: OD
Phone: 413-584-6616