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General NPI Number Information
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NPI Number | 1144025073
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Entity Type | Organization
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Legal Business Name | CONNECTICUT CONTACT LENS INSTITUTE LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 115 OLD RIDGEFIELD RD STE 101B
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City | WILTON
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State | CT
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Zip | 06897-3019
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Country | US
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Telephone | 203-834-0860
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Fax |
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Provider Business Mailing Address
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Address Line | 116 WELLS VIEW RD
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City | SHELTON
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State | CT
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Zip | 06484-5661
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Country | US
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Telephone | 203-232-3234
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JESSICA YU
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Credential | OD
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Telephone | 203-232-3234
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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 |
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License Number State |
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