Provider Demographics
NPI:1629547757
Name:EYE PHYSICIANS & SURGEONS, PC
Entity Type:Organization
Organization Name:EYE PHYSICIANS & SURGEONS, PC
Other - Org Name:EYE PHYSICIANS & SURGEONS, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-878-1236
Mailing Address - Street 1:202 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3502
Mailing Address - Country:US
Mailing Address - Phone:203-876-9202
Mailing Address - Fax:
Practice Address - Street 1:215 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3210
Practice Address - Country:US
Practice Address - Phone:203-226-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE PHYSICIAN & SURGEONS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty