1801818802 NPI number — WINDHAM EYE GROUP P.C.

Table of content: (NPI 1801818802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801818802 NPI number — WINDHAM EYE GROUP P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDHAM EYE GROUP P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801818802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 QUARRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIMANTIC
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06226-1238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-423-1619
Provider Business Mailing Address Fax Number:
860-423-7640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 QUARRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIMANTIC
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06226-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-423-1619
Provider Business Practice Location Address Fax Number:
860-423-7640
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOODS
Authorized Official First Name:
DANA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-423-1619

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010040216CT01 . This is a "BC/BS WOODS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 027147 . This is a "CONNECTICARE - PCR" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 24928 . This is a "AETNA PCR HMO & QPOS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 709097 . This is a "CONNECTICARE -WOODS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2747719 . This is a "AETNA WOODS HMO & QPO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001271477 . This is a "EDS CATON REARDON" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004129674 . This is a "EDS GROUP- WEG" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C14795 . This is a "MEDICARE RR" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001402164 . This is a "EDS WOODS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010027147CT01 . This is a "CATON REARDON" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 090002619CT01 . This is a "BC/BS CLARK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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