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General NPI Number Information
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NPI Number | 1902164148
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Entity Type | Organization
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Legal Business Name | EAST HAVEN EYE CARE, LLC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 135 SALTONSTALL PKWY
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City | EAST HAVEN
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State | CT
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Zip | 06512-2426
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Country | US
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Telephone | 203-265-7990
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Fax | 203-265-7998
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Provider Business Mailing Address
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Address Line | 135 SALTONSTALL PKWY
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City | EAST HAVEN
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State | CT
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Zip | 06512-2426
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST, OWNER
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Name | DR. MARC DENIGRIS
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Credential | O.D.
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Telephone | 203-265-7990
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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 | 001045
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License Number State | CT
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