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General NPI Number Information
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NPI Number | 1801943634
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Entity Type | Organization
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Legal Business Name | ADVANCED EYECARE, LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 314 FLANDERS RD SUITE 2C
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City | EAST LYME
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State | CT
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Zip | 06333-1727
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Country | US
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Telephone | 860-739-9900
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Fax | 860-739-0790
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Provider Business Mailing Address
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Address Line | 314 FLANDERS RD SUITE 2C
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City | EAST LYME
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State | CT
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Zip | 06333-1727
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Country | US
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Telephone | 860-739-9900
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Fax | 860-739-0790
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ELIZABETH C MCMUNN
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Credential | O.D.
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Telephone | 860-739-9900
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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 | 2594
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License Number State | CT
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