Provider Demographics
NPI:1417328139
Name:DR JOSEPH S MADRAK OD LLC
Entity Type:Organization
Organization Name:DR JOSEPH S MADRAK OD LLC
Other - Org Name:EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MADRAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-924-2175
Mailing Address - Street 1:7 RIVERSIDE DR, # 4
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-8164
Mailing Address - Country:US
Mailing Address - Phone:203-924-2175
Mailing Address - Fax:203-924-9232
Practice Address - Street 1:7 RIVERSIDE DR #4
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-8164
Practice Address - Country:US
Practice Address - Phone:203-924-2175
Practice Address - Fax:203-924-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty