Healthcare Provider Details

I. General information

NPI: 1801840723
Provider Name (Legal Business Name): HAWLEY LANE OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAWLEY LN
TRUMBULL CT
06611-5330
US

IV. Provider business mailing address

100 HAWLEY LN
TRUMBULL CT
06611-5330
US

V. Phone/Fax

Practice location:
  • Phone: 203-378-9462
  • Fax: 203-380-9823
Mailing address:
  • Phone: 203-378-9462
  • Fax: 203-380-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number001023
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number001023
License Number StateCT

VIII. Authorized Official

Name: MR. EDWARD AIMES
Title or Position: PRESIDENT
Credential: L.O.
Phone: 203-378-9462