Provider Demographics
NPI:1881808350
Name:AMHERST OPTICAL SHOPPE INC
Entity type:Organization
Organization Name:AMHERST OPTICAL SHOPPE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-256-6403
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01004-0549
Mailing Address - Country:US
Mailing Address - Phone:413-256-6403
Mailing Address - Fax:413-253-5412
Practice Address - Street 1:195 N PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1726
Practice Address - Country:US
Practice Address - Phone:413-256-6403
Practice Address - Fax:413-253-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1557156FX1800X
MA1974156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1507818Medicaid
MA1507818Medicaid