=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962162701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVON EYE ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2021
-----------------------------------------------------
Last Update Date | 12/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 AVON MEADOW LN
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06001-3753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-677-6444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 DIGGINS CT
-----------------------------------------------------
City | SOUTH WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06074-6917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-796-5039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRITTANY JONES
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 518-796-5039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------