Provider Demographics
NPI:1295866242
Name:STRATFORD EYECARE ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:STRATFORD EYECARE ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-378-2269
Mailing Address - Street 1:1040 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4968
Mailing Address - Country:US
Mailing Address - Phone:203-378-2269
Mailing Address - Fax:203-377-7207
Practice Address - Street 1:1040 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4968
Practice Address - Country:US
Practice Address - Phone:203-378-2269
Practice Address - Fax:203-377-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004199023Medicaid
CT004199023Medicaid