Healthcare Provider Details

I. General information

NPI: 1811063415
Provider Name (Legal Business Name): EYE CENTER OF SOUTHERN CONNECTICUT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 OLD DIXWELL AV
HAMDEN CT
06518
US

IV. Provider business mailing address

249 WEST MAIN STREET
BRANFORD CT
06405
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-6365
  • Fax: 203-281-2742
Mailing address:
  • Phone:
  • Fax: 203-483-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL E MASI
Title or Position: PRESIDENT
Credential: MD
Phone: 203-248-6365