Healthcare Provider Details

I. General information

NPI: 1730788688
Provider Name (Legal Business Name): NORWALK VISION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 EAST AVE STE 3C
NORWALK CT
06851-5736
US

IV. Provider business mailing address

148 EAST AVE STE 3C
NORWALK CT
06851-5736
US

V. Phone/Fax

Practice location:
  • Phone: 203-866-3280
  • Fax: 203-866-1124
Mailing address:
  • Phone: 203-866-3280
  • Fax: 203-866-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID JASON FOLMAN
Title or Position: OWNER, OPTOMETRIST
Credential: OD
Phone: 203-866-3280