Provider Demographics
NPI:1376716449
Name:PETER EUGENE LIBRE
Entity Type:Organization
Organization Name:PETER EUGENE LIBRE
Other - Org Name:CONNECTICUT GLAUCOMA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIBRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-853-2020
Mailing Address - Street 1:111 EAST AVE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5014
Mailing Address - Country:US
Mailing Address - Phone:203-853-2020
Mailing Address - Fax:203-852-9553
Practice Address - Street 1:111 EAST AVE
Practice Address - Street 2:SUITE 335
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5014
Practice Address - Country:US
Practice Address - Phone:203-853-2020
Practice Address - Fax:203-852-9553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER E LIBRE MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-09
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001338244Medicaid
NY01554461OtherMEDICAID NY
NY07J861OtherMEDICARE NY
NY01554461OtherMEDICAID NY
CT180000795Medicare PIN