Provider Demographics
NPI:1073561767
Name:CONSULTING OPHTHALMOLOGISTS, PC
Entity Type:Organization
Organization Name:CONSULTING OPHTHALMOLOGISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HIT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAZZOCCOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-678-0202
Mailing Address - Street 1:499 FARMINGTON AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3515
Mailing Address - Country:US
Mailing Address - Phone:860-674-7606
Mailing Address - Fax:860-678-0224
Practice Address - Street 1:499 FARMINGTON AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-674-7606
Practice Address - Fax:860-678-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004001624Medicaid
CD3799OtherRAILROAD MEDICARE
CTB83711Medicare UPIN
CD3799OtherRAILROAD MEDICARE
C00183Medicare PIN