Provider Demographics
NPI:1437790151
Name:VILLACIS EYECARE LLC
Entity Type:Organization
Organization Name:VILLACIS EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:CESAR
Authorized Official - Last Name:VILLACIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-755-4941
Mailing Address - Street 1:1320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3119
Mailing Address - Country:US
Mailing Address - Phone:203-755-4941
Mailing Address - Fax:203-573-8372
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3119
Practice Address - Country:US
Practice Address - Phone:203-755-4941
Practice Address - Fax:203-573-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty