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General NPI Number Information
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NPI Number | 1194915900
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Entity Type | Organization
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Legal Business Name | PROGRESSIVISION PC
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 3034 SUMMER ST
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City | STAMFORD
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State | CT
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Zip | 06905-4311
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Country | US
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Telephone | 203-975-7565
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Fax | 203-975-8303
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Provider Business Mailing Address
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Address Line | 3034 SUMMER ST
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City | STAMFORD
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State | CT
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Zip | 06905-4311
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Country | US
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Telephone | 203-975-7565
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Fax | 203-975-8303
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MICHAEL GERARD RAYHER
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Credential | OD
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Telephone | 203-975-7565
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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 | 2103
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License Number State | CT
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