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General NPI Number Information
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NPI Number | 1487869442
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Entity Type | Organization
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Legal Business Name | COLCHESTER EYE CARE, LLC
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 03/09/2019
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Provider Practice Location Address
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Address Line | 163 BROADWAY ST
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City | COLCHESTER
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State | CT
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Zip | 06415-1022
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Country | US
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Telephone | 860-537-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 163 BROADWAY ST
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City | COLCHESTER
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State | CT
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Zip | 06415-1022
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Country | US
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Telephone | 860-537-2020
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Fax |
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Authorized Official
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Title or Position | MANAGE
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Name | WENDY DEMPSEY
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Credential |
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Telephone | 860-228-1719
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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 | 002318
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License Number State | CT
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