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General NPI Number Information
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NPI Number | 1013193770
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Entity Type | Organization
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Legal Business Name | PARK LANE EYE CARE, INC
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Dates
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Enumeration Date | 01/12/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 50 BROAD ST
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City | MILFORD
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State | CT
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Zip | 06460-3358
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Country | US
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Telephone | 203-878-8260
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Fax |
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Provider Business Mailing Address
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Address Line | 50 BROAD ST
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City | MILFORD
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State | CT
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Zip | 06460-3358
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Country | US
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Telephone | 203-878-8260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES ROBERTS
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Credential | OD
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Telephone | 203-878-8260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 0454420001
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License Number State | CT
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