Provider Demographics
NPI:1114438652
Name:EYE SURGERY ASSOCIATES LLC
Entity Type:Organization
Organization Name:EYE SURGERY ASSOCIATES LLC
Other - Org Name:EYE SURGERY ASSOCIATES OPTICAL , LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-375-5819
Mailing Address - Street 1:495 HAWLEY LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1514
Mailing Address - Country:US
Mailing Address - Phone:203-375-5819
Mailing Address - Fax:203-377-4337
Practice Address - Street 1:495 HAWLEY LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1514
Practice Address - Country:US
Practice Address - Phone:203-375-5819
Practice Address - Fax:203-377-4337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE SURGERY ASSOICIATES,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty