Provider Demographics
NPI:1114582129
Name:KALLINEN EYE CARE, LLC
Entity Type:Organization
Organization Name:KALLINEN EYE CARE, LLC
Other - Org Name:GROTON EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:B
Authorized Official - Last Name:KALLINEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-445-1000
Mailing Address - Street 1:1041 POQUONNOCK RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4211
Mailing Address - Country:US
Mailing Address - Phone:860-445-1000
Mailing Address - Fax:
Practice Address - Street 1:1041 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4211
Practice Address - Country:US
Practice Address - Phone:860-445-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty