Healthcare Provider Details

I. General information

NPI: 1528029634
Provider Name (Legal Business Name): EYE CENTER OF SOUTHERN CONNECTICUT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 OLD DIXWELL AVE
HAMDEN CT
06518-3144
US

IV. Provider business mailing address

2880 OLD DIXWELL AVENUE
HAMDEN CT
06518
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-6365
  • Fax: 203-281-2742
Mailing address:
  • Phone: 203-248-6365
  • Fax: 203-281-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL E MASI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-248-6365