Provider Demographics
NPI:1225500663
Name:BLONDIN SHEA EYE CARE LLC
Entity Type:Organization
Organization Name:BLONDIN SHEA EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLONDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-489-2781
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-0448
Mailing Address - Country:US
Mailing Address - Phone:860-489-2781
Mailing Address - Fax:
Practice Address - Street 1:379 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5238
Practice Address - Country:US
Practice Address - Phone:860-489-2781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1831647247Medicaid
CT1750880209Medicaid
CT1386611762Medicaid
CT1447670401Medicaid