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General NPI Number Information
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NPI Number | 1144369588
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Entity Type | Organization
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Legal Business Name | EYECARE CENTER OF WATERBURY LLC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 625 WOLCOTT ST
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City | WATERBURY
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State | CT
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Zip | 06705-1342
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Country | US
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Telephone | 203-754-8339
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Fax |
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Provider Business Mailing Address
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Address Line | 625 WOLCOTT ST
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City | WATERBURY
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State | CT
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Zip | 06705-1342
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Country | US
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Telephone | 203-754-8339
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOHN JOSEPH PULASKI
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Credential | OD
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Telephone | 203-754-8339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 000910
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 000910
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License Number State | CT
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