Healthcare Provider Details

I. General information

NPI: 1699410803
Provider Name (Legal Business Name): SOSTILIO EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2379 BLACK ROCK TPKE
FAIRFIELD CT
06825-3229
US

IV. Provider business mailing address

2379 BLACK ROCK TPKE
FAIRFIELD CT
06825-3229
US

V. Phone/Fax

Practice location:
  • Phone: 203-333-5590
  • Fax: 203-333-6722
Mailing address:
  • Phone: 203-333-5590
  • Fax: 203-333-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS ERNEST SOSTILIO
Title or Position: OWNER
Credential: OD
Phone: 203-333-5590