Healthcare Provider Details

I. General information

NPI: 1316241466
Provider Name (Legal Business Name): NEW INSIGHT FAMILY EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
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 TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number896
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number896
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number896
License Number StateCT

VIII. Authorized Official

Name: DR. ALBERT EDWARD GERMAIN
Title or Position: PRES
Credential: OD
Phone: 203-755-4941