Healthcare Provider Details

I. General information

NPI: 1740603919
Provider Name (Legal Business Name): COMMONWEALTH EYECARE PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BICENTENNIAL HWY STE 101
SPRINGFIELD MA
01118-1965
US

IV. Provider business mailing address

275 BICENTENNIAL HWY STE 101
SPRINGFIELD MA
01118-1965
US

V. Phone/Fax

Practice location:
  • Phone: 413-783-3100
  • Fax: 413-782-7998
Mailing address:
  • Phone: 413-783-3100
  • Fax: 413-782-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number226532
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH PETER BOUVIER JR.
Title or Position: OWNER
Credential: M.D.
Phone: 413-783-3100