Healthcare Provider Details

I. General information

NPI: 1497729388
Provider Name (Legal Business Name): GEOFFREY T EMERICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 FARMINGTON AVE SUITE 100
FARMINGTON CT
06032-1943
US

IV. Provider business mailing address

499 FARMINGTON AVE SUITE 100
FARMINGTON CT
06032-1943
US

V. Phone/Fax

Practice location:
  • Phone: 860-678-0202
  • Fax: 860-678-0224
Mailing address:
  • Phone: 860-678-0202
  • Fax: 860-678-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0144192
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: