Healthcare Provider Details

I. General information

NPI: 1922724327
Provider Name (Legal Business Name): PROEYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 OLD KINGS HWY S LOWR LEVEL
DARIEN CT
06820-4552
US

IV. Provider business mailing address

36 OLD KINGS HWY S LOWR LEVEL
DARIEN CT
06820-4552
US

V. Phone/Fax

Practice location:
  • Phone: 845-269-5086
  • Fax:
Mailing address:
  • Phone: 845-269-5086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. INNA LAZAR
Title or Position: DOCTOR OF OPTOMETRY
Credential: OD
Phone: 845-269-5086