Provider Demographics
NPI:1215653977
Name:QUABBIN VALLEY EYE CARE CORPORATION
Entity type:Organization
Organization Name:QUABBIN VALLEY EYE CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OWNER/LICENSED OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED DISPENSING
Authorized Official - Phone:413-426-3024
Mailing Address - Street 1:1448 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069
Mailing Address - Country:US
Mailing Address - Phone:413-283-2946
Mailing Address - Fax:413-283-3631
Practice Address - Street 1:1448 NORTH MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069
Practice Address - Country:US
Practice Address - Phone:413-283-2946
Practice Address - Fax:413-283-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear Supplier