Provider Demographics
NPI:1346900412
Name:WILD APPLE EYE III LLC
Entity Type:Organization
Organization Name:WILD APPLE EYE III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-391-3366
Mailing Address - Street 1:34 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1515
Mailing Address - Country:US
Mailing Address - Phone:860-228-2020
Mailing Address - Fax:
Practice Address - Street 1:34 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1515
Practice Address - Country:US
Practice Address - Phone:860-228-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty