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General NPI Number Information
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NPI Number | 1114287505
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC ASSOCIATES OF BRISTOL, LLC
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 440 N MAIN ST STE B
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City | BRISTOL
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State | CT
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Zip | 06010-1902
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Country | US
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Telephone | 860-582-2166
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Fax | 860-582-8044
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Provider Business Mailing Address
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Address Line | 440 N MAIN ST STE B
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City | BRISTOL
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State | CT
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Zip | 06010-1902
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Country | US
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Telephone | 860-582-2166
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Fax | 860-582-8044
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Authorized Official
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Title or Position | OPTOMETRIST/MANAGER
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Name | DR. AMY HIMMELSTEIN
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Credential | O.D.
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Telephone | 860-582-2166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1085
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License Number State | CT
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