Provider Demographics
NPI:1609046580
Name:MONOPLEX EYE PROSTHETICS
Entity Type:Organization
Organization Name:MONOPLEX EYE PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED OCULARIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAZANOVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:508-347-3818
Mailing Address - Street 1:169 S RIVER RD
Mailing Address - Street 2:SUITE 14A
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6971
Mailing Address - Country:US
Mailing Address - Phone:603-622-5200
Mailing Address - Fax:603-644-2354
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1281
Practice Address - Country:US
Practice Address - Phone:508-347-3818
Practice Address - Fax:508-347-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4272380001Medicare NSC