Healthcare Provider Details

I. General information

NPI: 1073687984
Provider Name (Legal Business Name): PRIMARY EYE CARE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTHWESTERN DR
BLOOMFIELD CT
06002-3444
US

IV. Provider business mailing address

4 NORTHWESTERN DR
BLOOMFIELD CT
06002-3444
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-2020
  • Fax:
Mailing address:
  • Phone: 860-243-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM A BERNIER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 860-243-2020