1831647247 NPI number — MATTHEW BLONDIN, BLONDIN SHEA EYE CARE

Table of content: DR. TIMOTHY J ALFORD DDS MSD (NPI 1487717435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831647247 NPI number — MATTHEW BLONDIN, BLONDIN SHEA EYE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW BLONDIN, BLONDIN SHEA EYE CARE
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:
BLONDIN SHEA EYECARE
Provider Other Organization Name Type Code:
3
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:
1831647247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 448
Provider Second Line Business Mailing Address:
379 PROSPECT STREET, SUITE B
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-489-2781
Provider Business Mailing Address Fax Number:
860-489-9017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
379 PROSPECT STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-489-2781
Provider Business Practice Location Address Fax Number:
860-489-9017
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BLONDIN
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-489-2781

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  000845 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004024592 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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