1750461836 NPI number — EYE CARE ASSOCIATES

Table of content: (NPI 1750461836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750461836 NPI number — EYE CARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE ASSOCIATES
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:
1750461836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7035
Provider Second Line Business Mailing Address:
67 WATERBURY ROAD
Provider Business Mailing Address City Name:
PROSPECT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-758-6644
Provider Business Mailing Address Fax Number:
203-758-0429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 WATERBURY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-758-6644
Provider Business Practice Location Address Fax Number:
203-758-0429
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLINE
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-758-6644

Provider Taxonomy Codes

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

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

  • Identifier: 090000688CT . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: OVO488 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2037586644 . This is a "EYEFINITY ACCESS ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 688CT . This is a "STATE LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004023610 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006680 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 046241852 . This is a "VSP DOCTOR ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P384396 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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