Provider Demographics
NPI:1083745673
Name:EYE PHYSICIANS & SURGEONS, PC
Entity Type:Organization
Organization Name:EYE PHYSICIANS & SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-878-1236
Mailing Address - Street 1:1236 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3797
Mailing Address - Country:US
Mailing Address - Phone:203-488-5688
Mailing Address - Fax:203-483-9294
Practice Address - Street 1:1236 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3797
Practice Address - Country:US
Practice Address - Phone:203-488-5688
Practice Address - Fax:203-483-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00681OtherMEDICARE ID GROUP NUMBER
0265850007OtherDMED BRANFORD NUMBER
CT0265850007Medicare NSC