Individual
KIM MCGILLICUDDY MACIASZEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
426 N MAIN ST, EAST LONGMEADOW, MA 01028-1850
(413) 525-3010
(413) 525-7667
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3760
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0335622
—
MA
01
—
042472266
PRIVATE HEALTHCARE
—
01
—
042472266015
TRICARE CHAMPUS
—
01
—
2212894
FIRST HEALTH
—
01
—
410046213
RAILROAD MEDICARE
—
01
—
60892
FALLON COMMUNITY HEALTH
—
01
—
7252603
AETNA US HEALTHCARE
—
01
—
786726
MVP HEALTH CARE
—
01
—
8974875
CIGNA HEALTH PLAN
—
01
—
AA2839
HARVARD PILGRIM
—
01
—
W16304
BLUE CARE ELECT
—
01
—
W17219
MEDICARE B
—
Enumeration date
11/30/2005
Last updated
09/16/2024
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