Healthcare Provider Details

I. General information

NPI: 1487621819
Provider Name (Legal Business Name): EYE DISEASE CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 FARMINGTON AVE
WEST HARTFORD CT
06107-2110
US

IV. Provider business mailing address

1043 FARMINGTON AVE
WEST HARTFORD CT
06107-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-549-2020
  • Fax: 860-549-2025
Mailing address:
  • Phone: 860-549-2020
  • Fax: 860-549-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002692
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number041429
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number011792
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number011792
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number041429
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL ANTON GAUDIO
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 860-549-2020