Healthcare Provider Details
I. General information
NPI: 1679727218
Provider Name (Legal Business Name): CENTER FOR VISION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/10/2008
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
535 MONROE TPKE A-3
MONROE CT
06468-2382
US
IV. Provider business mailing address
535 MONROE TURNPIKE A-3
MONROE CT
06468
US
V. Phone/Fax
- Phone: 203-268-7799
- Fax: 203-261-3723
- Phone: 203-268-7799
- Fax: 203-261-3723
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
DENNIS
PAUL
IADAROLA
Title or Position: OWNER/ OPTOMETRIST
Credential: O.D
Phone: 203-268-7799