Healthcare Provider Details

I. General information

NPI: 1346686482
Provider Name (Legal Business Name): DR ANTWI EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 03/28/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 PARK RD
WEST HARTFORD CT
06119-2018
US

IV. Provider business mailing address

262 PARK RD
WEST HARTFORD CT
06119-2018
US

V. Phone/Fax

Practice location:
  • Phone: 860-206-8818
  • Fax: 860-206-4876
Mailing address:
  • Phone: 860-206-8818
  • Fax: 860-206-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number002871
License Number StateCT

VIII. Authorized Official

Name: AFUA WIREKOA ANTWI
Title or Position: AO
Credential: OD
Phone: 860-206-8818