MEDICARE: CITY OPTICIANS, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1346464393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OPTICIANS, PC

Provider Business Mailing Address
First Line	:	1624 MAIN ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 MAIN ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1224
Country	:	US
Telephone Number	:	413-737-3937
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH M DUDA
Credential	:	OD
Telephone Number	:	413-737-3937

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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