1891902037 NPI number — CONNECTICUT EYE CONSULTANTS, PC

Table of content: (NPI 1891902037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891902037 NPI number — CONNECTICUT EYE CONSULTANTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT EYE CONSULTANTS, PC
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:
DANBURY EYE PHYSICIANS OPTICAL SHOP
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:
1891902037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 SAND PIT RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06810-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-792-0090
Provider Business Mailing Address Fax Number:
203-778-6238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 SAND PIT RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-792-0090
Provider Business Practice Location Address Fax Number:
203-778-6238
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LANGE
Authorized Official First Name:
FIONA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
FINANCE AND COMPLIANCE MANAGER
Authorized Official Telephone Number:
203-791-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2050391000 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4001327 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4197514 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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