Provider Demographics
NPI:1083186746
Name:DAVID W. JOEL LLC
Entity Type:Organization
Organization Name:DAVID W. JOEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-397-3878
Mailing Address - Street 1:130 AMITY RD
Mailing Address - Street 2:FAMILY EYE CARE CENTER
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1405
Mailing Address - Country:US
Mailing Address - Phone:203-397-3878
Mailing Address - Fax:203-397-9110
Practice Address - Street 1:130 AMITY RD
Practice Address - Street 2:FAMILY EYE CARE CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1405
Practice Address - Country:US
Practice Address - Phone:203-397-3878
Practice Address - Fax:203-397-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004101218Medicaid