=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346871423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARIVISION-ADVANCED EYE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2020
-----------------------------------------------------
Last Update Date | 01/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 BLACK ROCK TURNPIKE
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-747-6299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 BERKSHIRE CT
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-747-6299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. HONGPING XU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-747-6299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------