Healthcare Provider Details

I. General information

NPI: 1750991345
Provider Name (Legal Business Name): CONNECTICUT CHILDRENS EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 FARMINGTON AVE, 2ND FLOOR STE 201
FARMINGTON CT
06032-2356
US

IV. Provider business mailing address

10 COLUMBUS BLVD
HARTFORD CT
06106-1976
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-9600
  • Fax:
Mailing address:
  • Phone: 860-837-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL RYCHWALSKI
Title or Position: PRESIDENT
Credential: MD
Phone: 860-545-9000