=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710993134
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERKSHIRE EYE CENTER, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 02/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 WILLIAMS ST
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-7463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-448-8559
-----------------------------------------------------
Fax | 413-499-9275
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 WILLIAMS ST
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-7463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-448-8559
-----------------------------------------------------
Fax | 413-499-9275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTICIAN
-----------------------------------------------------
Name | MR. THOMAS DAPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 413-448-8559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------