Healthcare Provider Details

I. General information

NPI: 1083186746
Provider Name (Legal Business Name): DAVID W. JOEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 AMITY RD FAMILY EYE CARE CENTER
NEW HAVEN CT
06515-1405
US

IV. Provider business mailing address

130 AMITY RD FAMILY EYE CARE CENTER
NEW HAVEN CT
06515-1405
US

V. Phone/Fax

Practice location:
  • Phone: 203-397-3878
  • Fax: 203-397-9110
Mailing address:
  • Phone: 203-397-3878
  • Fax: 203-397-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID W JOEL
Title or Position: OWNER
Credential: OD
Phone: 203-397-3878