Provider Demographics
NPI:1558039685
Name:VILLACIS EYECARE III, LLC
Entity Type:Organization
Organization Name:VILLACIS EYECARE III, LLC
Other - Org Name:NEW INSIGHT FAMILY EYECARE
Other - Org Type:Doing Business As
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:203-887-1265
Mailing Address - Street 1:1449 OLD WATERBURY RD
Mailing Address - Street 2:UNIT 304
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3926
Mailing Address - Country:US
Mailing Address - Phone:203-267-2020
Mailing Address - Fax:
Practice Address - Street 1:1449 OLD WATERBURY RD
Practice Address - Street 2:UNIT 304
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3926
Practice Address - Country:US
Practice Address - Phone:203-267-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty