Healthcare Provider Details

I. General information

NPI: 1821250952
Provider Name (Legal Business Name): ERIC JOHN PAPE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 MAIN ST SUITE 204
MIDDLETOWN CT
06457-3396
US

IV. Provider business mailing address

888 WORCESTER ST SUITE 130
WELLESLEY MA
02482-3744
US

V. Phone/Fax

Practice location:
  • Phone: 888-964-6681
  • Fax: 888-662-0859
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002747
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: