Provider Demographics
NPI:1609031046
Name:AGAWAM EYE ASSOCIATES, INC
Entity type:Organization
Organization Name:AGAWAM EYE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:GALLERANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-789-2106
Mailing Address - Street 1:656 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2130
Mailing Address - Country:US
Mailing Address - Phone:413-789-2106
Mailing Address - Fax:
Practice Address - Street 1:656 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2130
Practice Address - Country:US
Practice Address - Phone:413-789-2106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3134 3119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0352683Medicaid
MA0352683Medicaid
MA225458Medicare PIN