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General NPI Number Information
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NPI Number | 1992929384
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Entity Type | Organization
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Legal Business Name | OCULOFACIAL ASSOCIATES OF CONNECTICUT LLC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2 CORPORATE DR SUITE 112
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City | TRUMBULL
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State | CT
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Zip | 06611-1376
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Country | US
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Telephone | 203-452-9723
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Fax | 203-452-9724
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Provider Business Mailing Address
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Address Line | 2 CORPORATE DR SUITE 112
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City | TRUMBULL
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State | CT
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Zip | 06611-1376
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Country | US
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Telephone | 203-452-9723
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Fax | 203-452-9724
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Authorized Official
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Title or Position | OWNER
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Name | MARK RUCHMAN
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Credential | M.D.
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Telephone | 203-452-9723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 022088
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License Number State | CT
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