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General NPI Number Information
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NPI Number | 1295716413
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Entity Type | Organization
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Legal Business Name | MIDDLESEX EYE PHYSICIANS, P.C.
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 400 SAYBROOK RD SUITE 100
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4773
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Country | US
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Telephone | 860-347-7466
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Fax | 860-347-2619
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Provider Business Mailing Address
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Address Line | 400 SAYBROOK RD SUITE 100
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4773
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Country | US
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Telephone | 860-347-7466
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Fax | 860-347-2619
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER D LUSKIND
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Credential | M.D.
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Telephone | 860-347-7466
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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