Healthcare Provider Details

I. General information

NPI: 1811346166
Provider Name (Legal Business Name): VLADISLAV KOYFMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 12/12/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DR. EYEFIT LLC 25 CHURCH RD.
NEWTOWN CT
06470
US

IV. Provider business mailing address

DR. EYEFIT LLC 25 CHURCH HILL RD.
NEWTOWN CT
06470
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-5586
  • Fax: 203-426-3355
Mailing address:
  • Phone: 203-426-5586
  • Fax: 203-426-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9023TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56 008429
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number56 008429
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number56 008429
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number56 008429
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3.003243
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: