=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679727218
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR VISION CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2008
-----------------------------------------------------
Last Update Date | 12/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 MONROE TPKE A-3
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06468-2382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-268-7799
-----------------------------------------------------
Fax | 203-261-3723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 MONROE TURNPIKE A-3
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-268-7799
-----------------------------------------------------
Fax | 203-261-3723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ OPTOMETRIST
-----------------------------------------------------
Name | DR. DENNIS PAUL IADAROLA
-----------------------------------------------------
Credential | O.D
-----------------------------------------------------
Telephone | 203-268-7799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------