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General NPI Number Information
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NPI Number | 1194124453
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Entity Type | Organization
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Legal Business Name | EYEDOCARE,CORP
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 500 WESTFARMS MALL
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City | FARMINGTON
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State | CT
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Zip | 06032-2615
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Country | US
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Telephone | 860-674-6053
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Fax | 860-674-6079
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Provider Business Mailing Address
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Address Line | 12 WINSLOW RD
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City | WESTON
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State | CT
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Zip | 06883-1934
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Country | US
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Telephone | 516-547-6522
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUILLERMO GALLARDO
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Credential | MD
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Telephone | 516-547-6522
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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 | 050644
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License Number State | CT
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