Provider Demographics
NPI:1619034394
Name:PITTSFIELD VISION ASSOCIATES, PC
Entity Type:Organization
Organization Name:PITTSFIELD VISION ASSOCIATES, PC
Other - Org Name:FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINER-GOUDEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-499-3797
Mailing Address - Street 1:217 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6837
Mailing Address - Country:US
Mailing Address - Phone:413-499-3797
Mailing Address - Fax:413-499-3834
Practice Address - Street 1:217 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6837
Practice Address - Country:US
Practice Address - Phone:413-499-3797
Practice Address - Fax:413-499-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW21102Medicare PIN
MA5935890001Medicare NSC