=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265252902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLEASANT VIEW VISION CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2024
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 WILLIAMS ST
-----------------------------------------------------
City | LONGMEADOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01106-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-567-6450
-----------------------------------------------------
Fax | 413-754-6723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60834
-----------------------------------------------------
City | LONGMEADOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01116-0834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-323-6231
-----------------------------------------------------
Fax | 413-754-6723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIAL COORDINATOR
-----------------------------------------------------
Name | ANGELA THERESA KOWAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 413-323-6231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------