Healthcare Provider Details

I. General information

NPI: 1447438924
Provider Name (Legal Business Name): NORWICH OPHTHALMOLOGY GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 01/26/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 WAWECUS ST SUITE 105
NORWICH CT
06360-2160
US

IV. Provider business mailing address

79 WAWECUS ST SUITE 105
NORWICH CT
06360-2160
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-0161
  • Fax: 860-889-5999
Mailing address:
  • Phone: 860-886-0161
  • Fax: 860-889-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ANISH U SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 860-886-0161