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NPI Code Detail

MEDICARE: MYEYEDR OPTOMETRY OF CONNECTICUT, LLC

MEDICARE: MYEYEDR OPTOMETRY OF CONNECTICUT, LLC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1316570658
Entity Type Code : Organization
Provider Name (Legal Business Name) : MYEYEDR OPTOMETRY OF CONNECTICUT, LLC
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 775 MAIN ST S
Second Line :
City : SOUTHBURY
State : CT
Zip : 06488-2271
Country : US
Telephone Number : 203-262-6752
Fax Number : 203-262-6701
Authorized Official
Title or Position : SECRETARY
Name : SUE DOWNES
Credential :
Telephone Number : 703-847-8899
Provider Enumeration Date : 02/14/2020
Last Update Date : 05/23/2022

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