Healthcare Provider Details

I. General information

NPI: 1164622478
Provider Name (Legal Business Name): PINKE EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 COTS ST
SHELTON CT
06484-3866
US

IV. Provider business mailing address

9 COTS ST
SHELTON CT
06484-3866
US

V. Phone/Fax

Practice location:
  • Phone: 203-924-8800
  • Fax: 203-924-0388
Mailing address:
  • Phone: 203-924-8800
  • Fax:

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: KIM BEDINI
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 203-924-8800