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General NPI Number Information
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NPI Number | 1801445028
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Entity Type | Organization
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Legal Business Name | ENVISION 2020 EYECARE, LLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 380 W MAIN ST LENSCRAFTERS DOCTOR'S OFFICE
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City | AVON
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State | CT
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Zip | 06001-3690
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Country | US
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Telephone | 860-409-4565
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Fax | 860-831-1023
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Provider Business Mailing Address
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Address Line | 380 WEST MAIN STREET LENSCRAFTERS DOCTOR'S OFFICE
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City | AVON
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State | CT
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Zip | 06001
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Country | US
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Telephone | 860-409-4565
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Fax | 860-831-1023
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Authorized Official
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Title or Position | OWNER/ OPTOMETRIST
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Name | DR. SHARON F. HENDERSON
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Credential | OD
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Telephone | 860-597-7456
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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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