Provider Demographics
NPI:1134324205
Name:MANCHESTER OPHTHALMOLOGY, LLC
Entity Type:Organization
Organization Name:MANCHESTER OPHTHALMOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-649-5177
Mailing Address - Street 1:732 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5106
Mailing Address - Country:US
Mailing Address - Phone:860-649-5177
Mailing Address - Fax:860-643-4901
Practice Address - Street 1:732 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5106
Practice Address - Country:US
Practice Address - Phone:860-649-5177
Practice Address - Fax:860-643-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1266100001Medicare NSC