Healthcare Provider Details

I. General information

NPI: 1801324462
Provider Name (Legal Business Name): NORTHAMPTON VISION SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 MASONIC ST
NORTHAMPTON MA
01060-3026
US

IV. Provider business mailing address

86 MASONIC ST
NORTHAMPTON MA
01060-3026
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-5002
  • Fax:
Mailing address:
  • Phone: 413-586-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: THERESA J RUGGIERO
Title or Position: DOCTOR OF OPTOMETRY
Credential: OD
Phone: 413-586-5002