Healthcare Provider Details

I. General information

NPI: 1497705677
Provider Name (Legal Business Name): OPTICARE EYE HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 GRANDVIEW AVE
WATERBURY CT
06708-2514
US

IV. Provider business mailing address

87 GRANDVIEW AVE
WATERBURY CT
06708-2514
US

V. Phone/Fax

Practice location:
  • Phone: 203-574-2020
  • Fax: 203-596-2230
Mailing address:
  • Phone: 203-574-2020
  • Fax: 203-596-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0071
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: NANCY A NOLL
Title or Position: EXEC VICE PRES
Credential:
Phone: 203-574-2020