Provider Demographics
NPI:1346365145
Name:RAFFAELE INC
Entity Type:Organization
Organization Name:RAFFAELE INC
Other - Org Name:PEARLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YEHUDA
Authorized Official - Middle Name:EDDIE
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENCED OPTICIAN
Authorized Official - Phone:203-281-4330
Mailing Address - Street 1:2100 DIXWELL AVENUE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514
Mailing Address - Country:US
Mailing Address - Phone:203-281-4330
Mailing Address - Fax:203-288-4018
Practice Address - Street 1:2100 DIXWELL AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:203-281-4330
Practice Address - Fax:203-288-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001532332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT102188OtherEYE MED
CT100001532CT01OtherBLUE CROSS
CT21119OtherAVESIS
CT21119OtherAVESIS