Basic Information
| Provider Information | |||||||||
| NPI: | 1487833513 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUFFIELD EYE CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 162 MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | SUFFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060782091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606680266 | ||||||||
| FaxNumber: | 8606685556 | ||||||||
| Practice Location | |||||||||
| Address1: | 162 MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | SUFFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060782091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606680266 | ||||||||
| FaxNumber: | 8606685556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2007 | ||||||||
| LastUpdateDate: | 04/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | COLO | ||||||||
| AuthorizedOfficialFirstName: | ALEXIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8606680266 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.