Provider Demographics
NPI:1235335449
Name:STAMFORD EYE CARE PC
Entity Type:Organization
Organization Name:STAMFORD EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTENER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:KALUSTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-357-7181
Mailing Address - Street 1:30 6TH ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4610
Mailing Address - Country:US
Mailing Address - Phone:203-357-7181
Mailing Address - Fax:203-602-9986
Practice Address - Street 1:30 6TH ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4610
Practice Address - Country:US
Practice Address - Phone:203-357-7181
Practice Address - Fax:203-602-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008039500Medicaid
CTC02863Medicare ID - Type UnspecifiedGROUP NO