Provider Demographics
NPI:1114091501
Name:CATARACT & LASER CENTER WEST, LLC
Entity Type:Organization
Organization Name:CATARACT & LASER CENTER WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:C MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-737-5500
Mailing Address - Street 1:171 INTERSTATE DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-5101
Mailing Address - Country:US
Mailing Address - Phone:413-737-5500
Mailing Address - Fax:413-732-3514
Practice Address - Street 1:171 INTERSTATE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-5101
Practice Address - Country:US
Practice Address - Phone:413-737-5500
Practice Address - Fax:413-732-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
MAAJ4C261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1850288Medicaid
MACAM88012OtherBCBS
MA1850288Medicaid