Provider Demographics
NPI:1427383579
Name:CONNECTICUT ADVANCED EYECARE LLC
Entity Type:Organization
Organization Name:CONNECTICUT ADVANCED EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MAHA
Authorized Official - Middle Name:LAKSHMI
Authorized Official - Last Name:RAMAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MS
Authorized Official - Phone:860-529-5429
Mailing Address - Street 1:67 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3043
Mailing Address - Country:US
Mailing Address - Phone:860-529-5429
Mailing Address - Fax:860-563-5202
Practice Address - Street 1:67 WELLS RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3043
Practice Address - Country:US
Practice Address - Phone:860-529-5429
Practice Address - Fax:860-563-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2672152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty