Basic Information
| Provider Information | |||||||||
| NPI: | 1598711723 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONSULTING OPHTHALMOLOGISTS, P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CONSULTING OPTICAL | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 499 FARMINGTON AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606780202 | ||||||||
| FaxNumber: | 8606780224 | ||||||||
| Practice Location | |||||||||
| Address1: | 499 FARMINGTON AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606780202 | ||||||||
| FaxNumber: | 8606780224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 10/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | MAZZOCCOLI | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HIT | ||||||||
| AuthorizedOfficialTelephone: | 8606780202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CONSULTING OPHTHALMOLOGISTS, P.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | 001553 | CT | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | 0714730001 | 01 | MEDICARE DME | OTHER |