Provider Demographics
NPI:1083779219
Name:EYE PHYSICIANS OF CENTRAL CT PC
Entity Type:Organization
Organization Name:EYE PHYSICIANS OF CENTRAL CT PC
Other - Org Name:ADVANCED OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-235-2511
Mailing Address - Street 1:546 SO BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-630-3634
Mailing Address - Fax:203-639-0809
Practice Address - Street 1:546 SO BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450
Practice Address - Country:US
Practice Address - Phone:203-630-3634
Practice Address - Fax:203-639-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004086949Medicaid
0331140001Medicare NSC