Basic Information
| Provider Information | |||||||||
| NPI: | 1396192670 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECTICUT EYE ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1A BURTON HILLS BLVD | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152403809 | ||||||||
| FaxNumber: | 6152341809 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 WELLINGTON RD | ||||||||
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| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064611677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038782010 | ||||||||
| FaxNumber: | 2038772119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2016 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | CLENDENIN | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6156651283 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.