MEDICARE: OPTICARE EYE HEALTH CENTERS, INC.

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
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1356394993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICARE EYE HEALTH CENTERS, INC.

Provider Business Mailing Address
First Line	:	87 GRANDVIEW AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-2514
Country	:	US
Telephone Number	:	203-574-2020
Fax Number	:	203-596-2230

Provider Business Practice Location Address
First Line	:	17B GOVERNOR ST
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4608
Country	:	US
Telephone Number	:	203-438-5005
Fax Number	:	203-438-8403

Authorized Official
Title or Position	:	EXEC VP
Name	:	NANCY A NOLL
Credential	:
Telephone Number	:	203-574-2020

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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