Provider Demographics
NPI:1609880467
Name:SPRINGFIELD EYE ASSOCIATES INC
Entity Type:Organization
Organization Name:SPRINGFIELD EYE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-739-7367
Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-739-7367
Mailing Address - Fax:413-739-3808
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-739-7367
Practice Address - Fax:413-739-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM10812OtherMASS BLUE SHIELD GROUP #
MA718778OtherTUFTS GROUP #
MA011538OtherAETNA GROUP #
MA011538OtherAETNA GROUP #
MA1424660001Medicare NSC