Provider Demographics
NPI:1437285293
Name:EYEDR OF CONNECTICUT
Entity Type:Organization
Organization Name:EYEDR OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-348-3200
Mailing Address - Street 1:111 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2797
Mailing Address - Country:US
Mailing Address - Phone:203-348-3200
Mailing Address - Fax:
Practice Address - Street 1:111 BROAD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2797
Practice Address - Country:US
Practice Address - Phone:203-348-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0729630001Medicare ID - Type Unspecified