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General NPI Number Information
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NPI Number | 1902100795
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Entity Type | Organization
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Legal Business Name | VISION SOURCE OF AMHERST AND GREENFIELD
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/14/2012
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Provider Practice Location Address
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Address Line | 489 BERNARDSTON RD SUITE 101
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City | GREENFIELD
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State | MA
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Zip | 01301-1238
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Country | US
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Telephone | 413-772-2571
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Fax | 413-772-2266
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Provider Business Mailing Address
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Address Line | 489 BERNARDSTON RD SUITE 101
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City | GREENFIELD
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State | MA
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Zip | 01301-1238
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Country | US
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Telephone | 413-772-2571
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Fax | 413-772-2266
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | DR. BRIAN WINFIELD WADMAN
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Credential | O.D.
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Telephone | 413-772-2571
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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 | 3258
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License Number State | MA
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