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General NPI Number Information
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NPI Number | 1386621068
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Entity Type | Organization
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Legal Business Name | BAYSTATE EYE CARE OPTICAL SHOPPE
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 275 BICENTENNIAL HWY STE 101
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City | SPRINGFIELD
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State | MA
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Zip | 01118-1965
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Country | US
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Telephone | 413-783-3100
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Fax | 413-782-7998
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Provider Business Mailing Address
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Address Line | 275 BICENTENNIAL HWY STE 101
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City | SPRINGFIELD
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State | MA
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Zip | 01118-1965
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Country | US
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Telephone | 413-783-3100
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Fax | 413-782-7998
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN T BERGER
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Credential | M.D.
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Telephone | 413-783-3100
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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 | 2068
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License Number State | MA
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