Healthcare Provider Details

I. General information

NPI: 1538264973
Provider Name (Legal Business Name): EYE PHYSICIANS OF CENTRAL CT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 SO BROAD ST
MERIDEN CT
06450
US

IV. Provider business mailing address

546 SO BROAD ST
MERIDEN CT
06450
US

V. Phone/Fax

Practice location:
  • Phone: 203-235-2511
  • Fax: 203-639-0809
Mailing address:
  • Phone: 203-235-2511
  • Fax: 203-639-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WILLIAM C HALL
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 203-235-2511