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General NPI Number Information
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NPI Number | 1679030019
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Entity Type | Organization
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Legal Business Name | MYEYEDR OPTOMETRY OF MASSACHUSETTS P C
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 152 N KING ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-1120
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Country | US
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Telephone | 413-586-8456
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Fax | 413-582-0923
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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Fax | 571-223-6780
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Authorized Official
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Title or Position | SECRETARY
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Name | SUE HEALEY
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Credential |
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Telephone | 703-847-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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