Provider Demographics
NPI:1336268135
Name:EYE CARE WEST, INC
Entity Type:Organization
Organization Name:EYE CARE WEST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:413-733-2316
Mailing Address - Street 1:7 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:W SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2505
Mailing Address - Country:US
Mailing Address - Phone:413-733-2316
Mailing Address - Fax:413-732-4824
Practice Address - Street 1:7 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2505
Practice Address - Country:US
Practice Address - Phone:413-733-2316
Practice Address - Fax:413-732-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4976332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1536524Medicaid