Provider Demographics
NPI:1447430855
Name:ROBERT P. MINGRONE, O.D.
Entity Type:Organization
Organization Name:ROBERT P. MINGRONE, O.D.
Other - Org Name:LIFETIME EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MINGRONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-934-1400
Mailing Address - Street 1:153 SAW MILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4100
Mailing Address - Country:US
Mailing Address - Phone:203-934-1400
Mailing Address - Fax:203-933-6817
Practice Address - Street 1:153 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4100
Practice Address - Country:US
Practice Address - Phone:203-934-1400
Practice Address - Fax:203-933-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0905332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0595300001Medicare NSC