Healthcare Provider Details

I. General information

NPI: 1902026370
Provider Name (Legal Business Name): THE EYE CARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W MAIN ST SUITE 100
WATERBURY CT
06708
US

IV. Provider business mailing address

1201 WEST MAIN STREET SUITE 100
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 203-597-9100
  • Fax:
Mailing address:
  • Phone: 203-597-9100
  • 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 Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number000775
License Number StateCT

VIII. Authorized Official

Name: MS. JANE M CRAVEDI
Title or Position: BILLING MANAGER
Credential:
Phone: 203-573-4845