Basic Information
| Provider Information | |||||||||
| NPI: | 1972889657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPATCHER | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FELLOWS | ||||||||
| OtherFirstName: | MOLLY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 180 DAGGETT DR | ||||||||
| Address2: | |||||||||
| City: | WEST SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010894667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134524111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 33 RIDDELL ST | ||||||||
| Address2: | EYE & LASIK CENTER | ||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013012025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137747016 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2011 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5092 | MA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.