Provider Demographics
NPI:1437272119
Name:CHICOPEE EYECARE, P.C.
Entity Type:Organization
Organization Name:CHICOPEE EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOMNIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-592-7777
Mailing Address - Street 1:113 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-1667
Mailing Address - Country:US
Mailing Address - Phone:413-592-7777
Mailing Address - Fax:413-592-9704
Practice Address - Street 1:113 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1667
Practice Address - Country:US
Practice Address - Phone:413-592-7777
Practice Address - Fax:413-592-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000022244OtherBMC HEALTHNET
MA14538OtherHEALTH NEW ENGLAND
MAW20451OtherBLUE CROSS & BLUE SHIELD
MA9775871Medicaid
MAW20451OtherBLUE CROSS & BLUE SHIELD
MAW21106Medicare PIN
MAT59194Medicare UPIN