Healthcare Provider Details

I. General information

NPI: 1407017742
Provider Name (Legal Business Name): ERIKA WANDEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 11/03/2021
Certification Date: 12/16/2020
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 Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number52796
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number52796
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: