Healthcare Provider Details

I. General information

NPI: 1487869442
Provider Name (Legal Business Name): COLCHESTER EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 03/09/2019
Certification Date:
Deactivation Date: 08/06/2018
Reactivation Date: 03/09/2019

III. Provider practice location address

163 BROADWAY ST
COLCHESTER CT
06415-1022
US

IV. Provider business mailing address

163 BROADWAY ST
COLCHESTER CT
06415-1022
US

V. Phone/Fax

Practice location:
  • Phone: 860-537-2020
  • Fax:
Mailing address:
  • Phone: 860-537-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002318
License Number StateCT

VIII. Authorized Official

Name: WENDY DEMPSEY
Title or Position: MANAGE
Credential:
Phone: 860-228-1719