Provider Demographics
NPI:1073939302
Name:BIRCHWOOD OPTICAL
Entity Type:Organization
Organization Name:BIRCHWOOD OPTICAL
Other - Org Name:ADVANCED OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-235-2511
Mailing Address - Street 1:546 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6600
Mailing Address - Country:US
Mailing Address - Phone:203-235-2511
Mailing Address - Fax:203-639-0809
Practice Address - Street 1:325 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2548
Practice Address - Country:US
Practice Address - Phone:203-271-3103
Practice Address - Fax:203-272-1786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED EYE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier