Healthcare Provider Details

I. General information

NPI: 1114091501
Provider Name (Legal Business Name): CATARACT & LASER CENTER WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 INTERSTATE DR SUITE #1
WEST SPRINGFIELD MA
01089-5101
US

IV. Provider business mailing address

171 INTERSTATE DR SUITE #1
WEST SPRINGFIELD MA
01089-5101
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-5500
  • Fax: 413-732-3514
Mailing address:
  • Phone: 413-737-5500
  • Fax: 413-732-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAJ4C
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: C MICHAEL DUCA
Title or Position: ADMINISTRATOR
Credential:
Phone: 413-737-5500