Provider Demographics
NPI:1417072950
Name:VISION SHOWCASE
Entity Type:Organization
Organization Name:VISION SHOWCASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-584-8324
Mailing Address - Street 1:359 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3536
Mailing Address - Country:US
Mailing Address - Phone:413-584-8324
Mailing Address - Fax:413-584-9459
Practice Address - Street 1:359 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-3536
Practice Address - Country:US
Practice Address - Phone:413-584-8324
Practice Address - Fax:413-584-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5818332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1525662Medicaid
MA0980840002Medicare ID - Type Unspecified