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General NPI Number Information
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NPI Number | 1558473181
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Entity Type | Organization
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Legal Business Name | CHILDRENS EYE CARE PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 366 COLT HWY
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City | FARMINGTON
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State | CT
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Zip | 06032-2547
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Country | US
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Telephone | 860-409-0449
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Fax | 860-409-0551
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Provider Business Mailing Address
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Address Line | 366 COLT HWY
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City | FARMINGTON
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State | CT
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Zip | 06032-2547
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Country | US
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Telephone | 860-409-0449
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Fax | 860-409-0551
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL R. MITCHELL
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Credential | M.D
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Telephone | 860-409-0449
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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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