Provider Demographics
NPI:1144235847
Name:MADISON EYE CARE LLC
Entity Type:Organization
Organization Name:MADISON EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-245-8567
Mailing Address - Street 1:1347 BOSTON POST RD
Mailing Address - Street 2:#101
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1347 BOSTON POST RD
Practice Address - Street 2:#101
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3475
Practice Address - Country:US
Practice Address - Phone:203-245-8567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2652152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5793130001Medicare NSC