Provider Demographics
NPI:1568520773
Name:WESTFARMS EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:WESTFARMS EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-561-5687
Mailing Address - Street 1:61 WESTFARMS MALL D111
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2631
Mailing Address - Country:US
Mailing Address - Phone:860-561-5687
Mailing Address - Fax:860-561-8905
Practice Address - Street 1:61 WESTFARMS MALL D111
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2631
Practice Address - Country:US
Practice Address - Phone:860-561-5687
Practice Address - Fax:860-561-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U05078Medicare UPIN
C01275Medicare ID - Type Unspecified