Provider Demographics
NPI:1386208288
Name:NORWICH OPTOMETRY LLC
Entity Type:Organization
Organization Name:NORWICH OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-886-1155
Mailing Address - Street 1:22 SALEM TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6516
Mailing Address - Country:US
Mailing Address - Phone:860-886-1155
Mailing Address - Fax:860-308-1505
Practice Address - Street 1:22 SALEM TURNPIKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6516
Practice Address - Country:US
Practice Address - Phone:860-886-1155
Practice Address - Fax:860-308-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002700OtherSTATE LICENSE