Healthcare Provider Details

I. General information

NPI: 1538499124
Provider Name (Legal Business Name): UNITED OPTOMETRY RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WATERBURY RD
PROSPECT CT
06712-1250
US

IV. Provider business mailing address

60 WATERBURY RD P. O. BOX 7037
PROSPECT CT
06712-1250
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-0503
  • Fax: 203-758-0127
Mailing address:
  • Phone: 203-758-0503
  • Fax: 203-758-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002264
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number002264
License Number StateCT

VIII. Authorized Official

Name: TERRI CYR
Title or Position: OWNER
Credential: OD
Phone: 203-758-0503