Provider Demographics
NPI:1578091922
Name:QUARTZ EYE CARE LLC
Entity Type:Organization
Organization Name:QUARTZ EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:QUARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-796-7570
Mailing Address - Street 1:1907 WILBRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1822
Mailing Address - Country:US
Mailing Address - Phone:413-796-7570
Mailing Address - Fax:413-796-7573
Practice Address - Street 1:1907 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129-1822
Practice Address - Country:US
Practice Address - Phone:413-796-7570
Practice Address - Fax:413-796-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MATPAMA3060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110015992Medicaid