Provider Demographics
NPI:1225197551
Name:PROGRESSIVE EYE CARE INC
Entity Type:Organization
Organization Name:PROGRESSIVE EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-267-2020
Mailing Address - Street 1:1449 OLD WATERBURY RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3926
Mailing Address - Country:US
Mailing Address - Phone:203-267-2020
Mailing Address - Fax:203-267-2021
Practice Address - Street 1:1449 OLD WATERBURY RD
Practice Address - Street 2:SUITE 304
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3926
Practice Address - Country:US
Practice Address - Phone:203-267-2020
Practice Address - Fax:203-267-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004180684Medicaid
CTC02069Medicare ID - Type UnspecifiedGROUP NUMBER
CT004180684Medicaid