Healthcare Provider Details

I. General information

NPI: 1548480403
Provider Name (Legal Business Name): NEURO-OPHTHALMOLOGY & EYECARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036A BOSTON RD
WILBRAHAM MA
01095
US

IV. Provider business mailing address

2036A BOSTON RD
WILBRAHAM MA
01095-1102
US

V. Phone/Fax

Practice location:
  • Phone: 413-543-5444
  • Fax:
Mailing address:
  • Phone: 413-543-5444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number161328
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number161328
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number161328
License Number StateMA

VIII. Authorized Official

Name: DR. ERKAN MUTLUKAN
Title or Position: PROVIDER PHYSICIAN
Credential:
Phone: 413-543-5444