Provider Demographics
NPI:1073729505
Name:HEBRON EYE CARE LLC
Entity Type:Organization
Organization Name:HEBRON EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-228-1719
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:21 LIBERTY DRIVE
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-0771
Mailing Address - Country:US
Mailing Address - Phone:860-228-2020
Mailing Address - Fax:
Practice Address - Street 1:21 LIBERTY DRIVE
Practice Address - Street 2:UNIT A
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-0771
Practice Address - Country:US
Practice Address - Phone:860-228-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03449Medicare PIN