Healthcare Provider Details

I. General information

NPI: 1255083499
Provider Name (Legal Business Name): REFOCUS EYE HEALTH OF CENTRAL CONNECTICUT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 MAIN ST
MANCHESTER CT
06040-5106
US

IV. Provider business mailing address

87 GRANDVIEW AVE
WATERBURY CT
06708-2514
US

V. Phone/Fax

Practice location:
  • Phone: 860-649-5177
  • Fax:
Mailing address:
  • Phone: 203-574-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY RINKOV
Title or Position: CEO
Credential:
Phone: 203-574-2020