Provider Demographics
NPI:1639614332
Name:WATERBURY EYE CARE CENTER, PLC
Entity Type:Organization
Organization Name:WATERBURY EYE CARE CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:RANDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-279-8033
Mailing Address - Street 1:83 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1573
Mailing Address - Country:US
Mailing Address - Phone:802-244-1360
Mailing Address - Fax:
Practice Address - Street 1:83 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1573
Practice Address - Country:US
Practice Address - Phone:802-244-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty