Healthcare Provider Details

I. General information

NPI: 1386621068
Provider Name (Legal Business Name): BAYSTATE EYE CARE OPTICAL SHOPPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
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 Code332H00000X
TaxonomyEyewear Supplier
License Number2068
License Number StateMA

VIII. Authorized Official

Name: DR. STEVEN T BERGER
Title or Position: OWNER
Credential: M.D.
Phone: 413-783-3100