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General NPI Number Information
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NPI Number | 1801144456
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Entity Type | Organization
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Legal Business Name | RATCHFORD EYE CENTER LLC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 1166 FARMINGTON AVENUE
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City | BERLIN
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State | CT
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Zip | 06037-2302
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Country | US
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Telephone | 860-829-8939
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Fax | 860-829-8938
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Provider Business Mailing Address
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Address Line | 1166 FARMINGTON AVENUE
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City | BERLIN
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State | CT
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Zip | 06037
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Country | US
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Telephone | 860-829-8939
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Fax | 860-829-8938
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MARY GINA RATCHFORD
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Credential | M.D.
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Telephone | 860-829-8939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 001722
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License Number State | CT
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