Basic Information
| Provider Information | |||||||||
| NPI: | 1275061335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE CENTER OPTICAL, INC. | ||||||||
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| OtherOrganizationName: | ECO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 RIDDELL STREET | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137747016 | ||||||||
| FaxNumber: | 4137737596 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 HOSPITAL DRIVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135360006 | ||||||||
| FaxNumber: | 4135360029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2017 | ||||||||
| LastUpdateDate: | 06/01/2017 | ||||||||
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| AuthorizedOfficialLastName: | KENNIFF | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4137747016 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.