Basic Information
| Provider Information | |||||||||
| NPI: | 1952375792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSHLEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MATTHEW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 OLD FARMS RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060733723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536911066 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 499 FARMINGTON AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606780202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD00045759 | WA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 050431 | CT | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.