Healthcare Provider Details

I. General information

NPI: 1134398258
Provider Name (Legal Business Name): VISUAL EYES OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 FARMINGTON AVE 121
WEST HARTFORD CT
06119-1505
US

IV. Provider business mailing address

836 FARMINGTON AVE 121
WEST HARTFORD CT
06119-1505
US

V. Phone/Fax

Practice location:
  • Phone: 860-232-8800
  • Fax:
Mailing address:
  • Phone: 860-232-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOHN LANGE
Title or Position: OUNER
Credential:
Phone: 860-232-8800