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General NPI Number Information
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NPI Number | 1962632661
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Entity Type | Organization
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Legal Business Name | STAMFORD OPHTHALMOLOGY, LLC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 1351 WASHINGTON BLVD 101
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City | STAMFORD
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State | CT
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Zip | 06902
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Country | US
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Telephone | 203-327-5808
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Fax | 203-352-5199
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Provider Business Mailing Address
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Address Line | 1351 WASHINGTON BLVD 101
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City | STAMFORD
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State | CT
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Zip | 06902
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Country | US
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Telephone | 203-327-5808
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Fax | 203-352-5199
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH SIDERIDES
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Credential | MD
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Telephone | 203-327-5808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 001612
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 030718
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License Number State | CT
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