Provider Demographics
NPI:1437276169
Name:HARTFORD EYE PHYSICIANS
Entity Type:Organization
Organization Name:HARTFORD EYE PHYSICIANS
Other - Org Name:RIVER PARK OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-633-6634
Mailing Address - Street 1:51 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3821
Mailing Address - Country:US
Mailing Address - Phone:860-676-1666
Mailing Address - Fax:860-676-1462
Practice Address - Street 1:51 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3821
Practice Address - Country:US
Practice Address - Phone:860-676-1666
Practice Address - Fax:860-676-1462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARTFORD EYE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026368CT332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment