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General NPI Number Information
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NPI Number | 1518331230
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Entity Type | Organization
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Legal Business Name | MYEYEDR OPTOMETRY OF CONNECTICUT, LLC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 1249 W MAIN ST STE 1
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City | WATERBURY
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State | CT
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Zip | 06708-3100
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Country | US
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Telephone | 203-805-7022
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Fax | 877-596-8392
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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Fax | 571-223-6780
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Authorized Official
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Title or Position | SECRETARY
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Name | SUE DOWNES
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Credential |
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Telephone | 703-847-8899
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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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