Provider Demographics
NPI:1417198516
Name:EYE PHYSICIANS & SURGEONS, PC
Entity Type:Organization
Organization Name:EYE PHYSICIANS & SURGEONS, PC
Other - Org Name:OD'S
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SPROTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-878-1236
Mailing Address - Street 1:2 TRAP FALLS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4616
Mailing Address - Country:US
Mailing Address - Phone:203-944-0464
Mailing Address - Fax:203-944-0344
Practice Address - Street 1:2 TRAP FALLS RD STE 104
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4616
Practice Address - Country:US
Practice Address - Phone:203-944-0464
Practice Address - Fax:203-944-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004195063 OD'S T19GRMedicaid