Provider Demographics
NPI:1124742077
Name:P& N VISION HEALTH CARE SERVICE
Entity type:Organization
Organization Name:P& N VISION HEALTH CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMIDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:NCHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-250-8378
Mailing Address - Street 1:100 GROVE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2630
Mailing Address - Country:US
Mailing Address - Phone:508-250-8378
Mailing Address - Fax:
Practice Address - Street 1:100 GROVE ST STE 103
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2630
Practice Address - Country:US
Practice Address - Phone:508-250-8378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty