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General NPI Number Information
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NPI Number | 1255496030
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Entity Type | Organization
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Legal Business Name | BERKSHIRE EYE CENTER, P.C.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 342 STOCKBRIDGE RD KMART PLAZA
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City | GREAT BARRINGTON
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State | MA
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Zip | 01230-1235
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Country | US
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Telephone | 413-528-8911
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Fax | 413-528-2711
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Provider Business Mailing Address
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Address Line | 342 STOCKBRIDGE RD KMART PLAZA
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City | GREAT BARRINGTON
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State | MA
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Zip | 01230-1235
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Country | US
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Telephone | 413-528-8911
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Fax | 413-528-2711
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE G. EVENCHIK
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Credential | M.D.
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Telephone | 413-445-4564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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