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General NPI Number Information
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NPI Number | 1457010688
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Entity Type | Organization
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Legal Business Name | TRIBURY EYE CARE
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 175 MAIN ST S STE 2
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City | WOODBURY
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State | CT
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Zip | 06798-3448
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Country | US
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Telephone | 215-805-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 4 HIGHRIDGE RD UNIT 4
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City | MIDDLEBURY
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State | CT
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Zip | 06762-2946
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Country | US
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Telephone | 215-805-4299
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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. TARA BAIDEME
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Credential | O.D.
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Telephone | 215-805-4299
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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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