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NPI Code Detail

MEDICARE: FANG VISION CARE LLC

MEDICARE: FANG VISION CARE 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
1152W00000XOptometrist2864CT

General Provider Information

NPI Number : 1972048460
Entity Type Code : Organization
Provider Name (Legal Business Name) : FANG VISION CARE LLC
Provider Business Mailing Address
First Line : 420 BUCKLAND HILLS DR
Second Line : VISION CENTER
City : MANCHESTER
State : CT
Zip : 06042-8755
Country : US
Telephone Number : 860-644-1203
Fax Number :
Provider Business Practice Location Address
First Line : 420 BUCKLAND HILLS DR
Second Line : VISION CENTER
City : MANCHESTER
State : CT
Zip : 06042-8755
Country : US
Telephone Number : 860-644-1203
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. XIAOMIN FANG
Credential : O.D.
Telephone Number : 860-920-9390
Provider Enumeration Date : 12/20/2016
Last Update Date : 12/20/2016

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