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General NPI Number Information
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NPI Number | 1942459615
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Entity Type | Organization
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Legal Business Name | CONNECTICUT VISION CENTER, LLC
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 64 THOMPSON ST SUITE B104
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City | EAST HAVEN
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State | CT
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Zip | 06513-5707
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Country | US
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Telephone | 203-469-1012
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Fax | 203-467-1369
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Provider Business Mailing Address
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Address Line | 64 THOMPSON ST STE B104
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City | EAST HAVEN
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State | CT
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Zip | 06513-5701
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Country | US
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Telephone | 203-469-1012
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Fax | 203-467-1369
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MARIA I DIAZ
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Credential |
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Telephone | 203-469-1012
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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 | 2426
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License Number State | CT
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