Provider Demographics
NPI:1508089202
Name:PROFESSIONAL EYECARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL EYECARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-767-6328
Mailing Address - Street 1:DR THOMAS ENG
Mailing Address - Street 2:2844 RESERVOIR AVE
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4507
Mailing Address - Country:US
Mailing Address - Phone:203-767-6328
Mailing Address - Fax:
Practice Address - Street 1:DR THOMAS ENG
Practice Address - Street 2:1330 BOSTON POST ROAD
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2711
Practice Address - Country:US
Practice Address - Phone:203-877-6593
Practice Address - Fax:203-877-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT#2117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03698Medicare PIN