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NPI Code Detail

MEDICARE: FAMILY VISION CENTER LLC

MEDICARE: FAMILY VISION CENTER 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
1152W00000XOptometrist000660CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548256647
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY VISION CENTER LLC
Provider Business Mailing Address
First Line : 775 MAIN ST
Second Line :
City : STRATFORD
State : CT
Zip : 06615-7406
Country : US
Telephone Number : 203-377-2020
Fax Number : 203-381-9936
Provider Business Practice Location Address
First Line : 775 MAIN ST
Second Line :
City : STRATFORD
State : CT
Zip : 06615-7406
Country : US
Telephone Number : 203-377-2020
Fax Number : 203-381-9936
Authorized Official
Title or Position : PRESIDENT
Name : DR. MICHAEL J GORMAN
Credential : OD
Telephone Number : 203-377-2020
Provider Enumeration Date : 09/23/2005
Last Update Date : 04/02/2009

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Directions to “FAMILY VISION CENTER LLC ” Practice Location

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