Provider Demographics
NPI:1972601912
Name:MERLIN, JAMES IRA (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:IRA
Last Name:MERLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 CONWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1521
Mailing Address - Country:US
Mailing Address - Phone:413-774-6301
Mailing Address - Fax:413-772-3395
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1521
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:413-772-3395
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110016183AMedicaid
MA3359OtherMA STATE LICENSE
MA41965801Medicare PIN
MA3359OtherMA STATE LICENSE
MAT79632Medicare UPIN
MA41965801Medicare PIN
MA3359OtherMA STATE LICENSE
MAT79632Medicare UPIN