MEDICARE: QUABBIN VALLEY EYE CARE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	152WC0802X	Corneal and Contact Management Optometrist
3	156FC0801X	Contact Lens Fitter
4	156FX1202X	Optometric Technician
5	156FX1800X	Optician
6	332H00000X	Eyewear Supplier
7	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1215653977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUABBIN VALLEY EYE CARE CORPORATION

Provider Business Mailing Address
First Line	:	1448 NORTH MAIN STREET
Second Line	:	SUITE 1
City	:	PALMER
State	:	MA
Zip	:	01069
Country	:	US
Telephone Number	:	413-283-2946
Fax Number	:	413-283-3631

Provider Business Practice Location Address
First Line	:	1448 NORTH MAIN STREET
Second Line	:	SUITE 1
City	:	PALMER
State	:	MA
Zip	:	01069
Country	:	US
Telephone Number	:	413-283-2946
Fax Number	:	413-283-3631

Authorized Official
Title or Position	:	PRINCIPAL OWNER/LICENSED OPTICIAN
Name	:	MRS. REBECCA LYNN MAURER
Credential	:	LICENSED DISPENSING
Telephone Number	:	413-426-3024

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	03/17/2023

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