Provider Demographics
NPI:1881884856
Name:THE LIONS ORTHOPTIC CLINIC OF WESTERN MA INC
Entity type:Organization
Organization Name:THE LIONS ORTHOPTIC CLINIC OF WESTERN MA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-527-8318
Mailing Address - Street 1:130 MAPLE ST
Mailing Address - Street 2:SUITE 326
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2202
Mailing Address - Country:US
Mailing Address - Phone:413-739-0147
Mailing Address - Fax:413-739-0146
Practice Address - Street 1:130 MAPLE ST
Practice Address - Street 2:SUITE 326
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2202
Practice Address - Country:US
Practice Address - Phone:413-739-0147
Practice Address - Fax:413-739-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13955OtherHNE
MA613568OtherTUFTS
MA613568OtherTUFTS