Healthcare Provider Details

I. General information

NPI: 1134324205
Provider Name (Legal Business Name): MANCHESTER OPHTHALMOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 MAIN ST
MANCHESTER CT
06040-5106
US

IV. Provider business mailing address

732 MAIN ST
MANCHESTER CT
06040-5106
US

V. Phone/Fax

Practice location:
  • Phone: 860-649-5177
  • Fax: 860-643-4901
Mailing address:
  • Phone: 860-649-5177
  • Fax: 860-643-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD D. CARLTON
Title or Position: OWNER
Credential: M.D.
Phone: 860-649-5177