Healthcare Provider Details

I. General information

NPI: 1699114173
Provider Name (Legal Business Name): OCULUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 FARMINGTON AVE LENSCRAFTERS
BRISTOL CT
06010-4216
US

IV. Provider business mailing address

72 FARMINGTON AVE LENSCRAFTERS
BRISTOL CT
06010-4216
US

V. Phone/Fax

Practice location:
  • Phone: 860-793-9711
  • Fax:
Mailing address:
  • Phone: 860-793-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2469
License Number StateCT

VIII. Authorized Official

Name: DR. JENNY CHA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 860-343-6016