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NPI Code Detail

MEDICARE: PROGRESSIVISION PC

MEDICARE: PROGRESSIVISION PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2103CT

General Provider Information

NPI Number : 1194915900
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESSIVISION PC
Provider Business Mailing Address
First Line : 3034 SUMMER ST
Second Line :
City : STAMFORD
State : CT
Zip : 06905-4311
Country : US
Telephone Number : 203-975-7565
Fax Number : 203-975-8303
Provider Business Practice Location Address
First Line : 3034 SUMMER ST
Second Line :
City : STAMFORD
State : CT
Zip : 06905-4311
Country : US
Telephone Number : 203-975-7565
Fax Number : 203-975-8303
Authorized Official
Title or Position : VICE PRESIDENT
Name : DR. MICHAEL GERARD RAYHER
Credential : OD
Telephone Number : 203-975-7565
Provider Enumeration Date : 07/27/2007
Last Update Date : 07/27/2007

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Directions to “PROGRESSIVISION PC ” Practice Location

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