Provider Demographics
NPI:1033244330
Name:OPTICAL STUDIO, LLC
Entity Type:Organization
Organization Name:OPTICAL STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIBETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ERB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-584-6616
Mailing Address - Street 1:274 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3953
Mailing Address - Country:US
Mailing Address - Phone:413-584-6616
Mailing Address - Fax:
Practice Address - Street 1:274 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3953
Practice Address - Country:US
Practice Address - Phone:413-584-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty