Healthcare Provider Details

I. General information

NPI: 1700722030
Provider Name (Legal Business Name): VILLACIS EYECARE V, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 WHITNEY AVE
HAMDEN CT
06517-1204
US

IV. Provider business mailing address

1970 WHITNEY AVE
HAMDEN CT
06517-1204
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-3937
  • Fax:
Mailing address:
  • Phone: 203-248-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: FABIAN CESAR VILLACIS
Title or Position: OWNER
Credential: OD
Phone: 203-248-3937