MEDICARE: DR. IRENE ELAINE ANTAR OD

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	152W00000X	Optometrist	3160	CT

General Provider Information

NPI Number	:	1528670783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENE ELAINE ANTAR OD

Provider Business Mailing Address
First Line	:	49 TURNPIKE SQ
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-2758
Country	:	US
Telephone Number	:	203-878-3098
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 TURNPIKE SQ
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-2758
Country	:	US
Telephone Number	:	203-878-3098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	01/19/2022

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