Provider Demographics
NPI:1104838846
Name:EYECARE CENTER OF STAMFORD, LLC
Entity Type:Organization
Organization Name:EYECARE CENTER OF STAMFORD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-978-0800
Mailing Address - Street 1:1275 SUMMER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5359
Mailing Address - Country:US
Mailing Address - Phone:203-978-0800
Mailing Address - Fax:203-978-1284
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5359
Practice Address - Country:US
Practice Address - Phone:203-978-0800
Practice Address - Fax:203-978-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028681207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty