Provider Demographics
NPI:1972726115
Name:SHEA, THOMAS E (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:SHEA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1816
Mailing Address - Country:US
Mailing Address - Phone:413-592-1199
Mailing Address - Fax:
Practice Address - Street 1:33 GROVE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1816
Practice Address - Country:US
Practice Address - Phone:413-592-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2071156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0313441Medicaid
MA1265760001Medicare PIN