Provider Demographics
NPI:1346686482
Name:DR ANTWI EYECARE LLC
Entity Type:Organization
Organization Name:DR ANTWI EYECARE LLC
Other - Org Name:EYES ON PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:AFUA
Authorized Official - Middle Name:WIREKOA
Authorized Official - Last Name:ANTWI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-206-8818
Mailing Address - Street 1:262 PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2018
Mailing Address - Country:US
Mailing Address - Phone:860-206-8818
Mailing Address - Fax:860-206-4876
Practice Address - Street 1:262 PARK RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2018
Practice Address - Country:US
Practice Address - Phone:860-206-8818
Practice Address - Fax:860-206-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002871261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care