Provider Demographics
NPI:1669609152
Name:COLBERT, AILSA H (OD)
Entity type:Individual
Prefix:DR
First Name:AILSA
Middle Name:H
Last Name:COLBERT
Suffix:
Gender:F
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:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-0448
Mailing Address - Country:US
Mailing Address - Phone:240-205-3763
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:NORTHAMPTON HEALTH CENTER
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1466
Practice Address - Country:US
Practice Address - Phone:413-586-8400
Practice Address - Fax:413-585-5463
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4436152W00000X
MA4852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA231044OtherHARVARD PILGRIM HEALTHCARE
MA110090192AMedicaid
MA53059OtherHEALTH NEW ENGLAND
MA110090192AMedicaid