Provider Demographics
NPI:1740603919
Name:COMMONWEALTH EYECARE PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:COMMONWEALTH EYECARE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:BOUVIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:413-783-3100
Mailing Address - Street 1:275 BICENTENNIAL HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1965
Mailing Address - Country:US
Mailing Address - Phone:413-783-3100
Mailing Address - Fax:413-782-7998
Practice Address - Street 1:275 BICENTENNIAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1965
Practice Address - Country:US
Practice Address - Phone:413-783-3100
Practice Address - Fax:413-782-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
MA226532207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1740603919OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MA1740603919OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS