Healthcare Provider Details

I. General information

NPI: 1942701255
Provider Name (Legal Business Name): RIDGEFIELD EYE PHYSICIANS & SURGEONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38B GROVE ST STE LC
RIDGEFIELD CT
06877-4665
US

IV. Provider business mailing address

38B GROVE ST STE LC
RIDGEFIELD CT
06877-4665
US

V. Phone/Fax

Practice location:
  • Phone: 917-892-0222
  • Fax:
Mailing address:
  • Phone: 917-892-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number054024
License Number StateCT

VIII. Authorized Official

Name: MIRELA KRASNIQI
Title or Position: PRESIDENT
Credential: MD
Phone: 917-892-0222