Basic Information
| Provider Information | |||||||||
| NPI: | 1477524239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELVILLE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | KEVIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 249 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064054048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034832000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 249 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064054048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034832000 | ||||||||
| FaxNumber: | 2034832002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME90641 | FL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 14789 | NE | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 72389 | CT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 10025428000 | 05 | NE | MEDICAID | 007827400 | 05 | FL | MEDICAID | 200410430A | 05 | KS | MEDICAID | 03126 | 01 | NE | BCBS | OTHER | 50086 | 01 | FL | BC/BS FLORIDA | OTHER |