Provider Demographics
NPI:1710165709
Name:SOUTHWICK OPTICIANS INC.
Entity Type:Organization
Organization Name:SOUTHWICK OPTICIANS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERHOOF
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:413-569-6446
Mailing Address - Street 1:610 COLLEGE HWY
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9106
Mailing Address - Country:US
Mailing Address - Phone:413-569-6446
Mailing Address - Fax:413-569-0890
Practice Address - Street 1:610 COLLEGE HWY
Practice Address - Street 2:SUITE 8A
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9106
Practice Address - Country:US
Practice Address - Phone:413-569-6446
Practice Address - Fax:413-569-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1951332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier