Healthcare Provider Details

I. General information

NPI: 1295773893
Provider Name (Legal Business Name): CONNECTICUT EYE CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 SAND PIT RD SUITE 101
DANBURY CT
06810-4004
US

IV. Provider business mailing address

69 SAND PIT RD SUITE 101
DANBURY CT
06810-4004
US

V. Phone/Fax

Practice location:
  • Phone: 203-791-2020
  • Fax: 203-778-6238
Mailing address:
  • Phone: 203-791-2020
  • Fax: 203-778-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2050391000
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2050391000
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. FIONA B LANGE
Title or Position: BUSINESS OFFICE SUPERVISOR
Credential:
Phone: 203-791-2020