Provider Demographics
NPI:1114986346
Name:HARTFORD EYE PHYSICIANS PC
Entity Type:Organization
Organization Name:HARTFORD EYE PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-633-6634
Mailing Address - Street 1:55 NYE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1281
Mailing Address - Country:US
Mailing Address - Phone:860-633-6634
Mailing Address - Fax:860-652-3291
Practice Address - Street 1:55 NYE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1281
Practice Address - Country:US
Practice Address - Phone:860-633-6634
Practice Address - Fax:860-652-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0351860002OtherMEDICARE DURABLE MEDICAL EQUIPMENT PROVIDER NUMBER
CT004001640Medicaid
CT004001640Medicaid