Healthcare Provider Details

I. General information

NPI: 1568810927
Provider Name (Legal Business Name): CLEAR HORIZON EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W MAIN ST
PLAINVILLE CT
06062-1944
US

IV. Provider business mailing address

PO BOX 28
PLAINVILLE CT
06062-0028
US

V. Phone/Fax

Practice location:
  • Phone: 860-747-6443
  • Fax: 860-747-8019
Mailing address:
  • Phone: 860-747-6443
  • Fax: 860-747-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier004061420
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 2
Identifier500000343
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer

VIII. Authorized Official

Name: DR. ERIN LORRAINE MCCLEARY
Title or Position: OPTOMETRIST / OWNER
Credential: OD
Phone: 860-747-6443