Provider Demographics
NPI:1497366637
Name:ONCE OPTICAL GROUP LLC
Entity Type:Organization
Organization Name:ONCE OPTICAL GROUP LLC
Other - Org Name:WATERBURY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONCE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:203-528-7701
Mailing Address - Street 1:87 FOX ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3401
Mailing Address - Country:US
Mailing Address - Phone:203-528-7701
Mailing Address - Fax:
Practice Address - Street 1:501 FROST RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2347
Practice Address - Country:US
Practice Address - Phone:203-437-8186
Practice Address - Fax:203-437-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT332H00000XMedicaid