Provider Demographics
NPI:1770569964
Name:PIONEER VALLEY EYE SURGERY AND LASER CENTER, LLC
Entity type:Organization
Organization Name:PIONEER VALLEY EYE SURGERY AND LASER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-783-3100
Mailing Address - Street 1:275 BICENTENNIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1900
Mailing Address - Country:US
Mailing Address - Phone:413-783-3100
Mailing Address - Fax:413-782-7998
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2377
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:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANONE261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA681722OtherTUFTS
MAM88017OtherBLUE SHIELD OF MASSACHUSE
MA=========OtherTAX I.D. #
MAM88017OtherBLUE SHIELD OF MASSACHUSE