Healthcare Provider Details

I. General information

NPI: 1437790151
Provider Name (Legal Business Name): VILLACIS EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
WATERBURY CT
06708-3119
US

IV. Provider business mailing address

1320 W MAIN ST
WATERBURY CT
06708-3119
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-4941
  • Fax: 203-573-8372
Mailing address:
  • Phone: 203-755-4941
  • Fax: 203-573-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. FABIAN CESAR VILLACIS
Title or Position: OWNER
Credential: OD
Phone: 203-755-4941