MEDICARE: EYECARE CENTER OF STAMFORD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	028681	CT

General Provider Information

NPI Number	:	1104838846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYECARE CENTER OF STAMFORD, LLC

Provider Business Mailing Address
First Line	:	1275 SUMMER ST
Second Line	:	SUITE 200
City	:	STAMFORD
State	:	CT
Zip	:	06905-5359
Country	:	US
Telephone Number	:	203-978-0800
Fax Number	:	203-978-1284

Provider Business Practice Location Address
First Line	:	1275 SUMMER ST
Second Line	:	SUITE 200
City	:	STAMFORD
State	:	CT
Zip	:	06905-5359
Country	:	US
Telephone Number	:	203-978-0800
Fax Number	:	203-978-1284

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. ERIC L WASSERMAN
Credential	:	M.D.
Telephone Number	:	203-978-0800

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	08/22/2020

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