Provider Demographics
NPI:1336458868
Name:FREDRIC I. SMILEN O.D., P.C.
Entity Type:Organization
Organization Name:FREDRIC I. SMILEN O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:I
Authorized Official - Last Name:SMILEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-348-3937
Mailing Address - Street 1:100 GREYROCK PL
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3118
Mailing Address - Country:US
Mailing Address - Phone:203-348-3937
Mailing Address - Fax:
Practice Address - Street 1:100 GREYROCK PL
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3118
Practice Address - Country:US
Practice Address - Phone:203-348-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
410000816Medicare PIN
CTU65709Medicare UPIN