Provider Demographics
NPI:1992980478
Name:BELCHERTOWN EYE CARE
Entity type:Organization
Organization Name:BELCHERTOWN EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MASTER OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:413-323-1196
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-0042
Mailing Address - Country:US
Mailing Address - Phone:413-323-1196
Mailing Address - Fax:413-323-1186
Practice Address - Street 1:142 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9433
Practice Address - Country:US
Practice Address - Phone:413-323-1196
Practice Address - Fax:413-323-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4856156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA4856OtherEYEMED
MA0338061Medicaid
MA4529500001Medicare PIN
MAMA4856OtherEYEMED