Healthcare Provider Details

I. General information

NPI: 1487683470
Provider Name (Legal Business Name): NEW ENGLAND EYECARE OF MANCHESTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 BROAD ST
MANCHESTER CT
06040-4036
US

IV. Provider business mailing address

397 BROAD ST
MANCHESTER CT
06040-4036
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-6655
  • Fax: 860-647-7872
Mailing address:
  • Phone: 860-646-6655
  • Fax: 860-647-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DAVID STURGIS
Title or Position: OWNER/PRESIDENT
Credential: O.D.
Phone: 860-646-6655