Provider Demographics
NPI:1659319598
Name:OPHTHALMIC CONSULTANTS OF CONNECTICUT PC
Entity Type:Organization
Organization Name:OPHTHALMIC CONSULTANTS OF CONNECTICUT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:THIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-366-8000
Mailing Address - Street 1:825 E GATE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2136
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:516-240-6540
Practice Address - Street 1:1375 KINGS HWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5318
Practice Address - Country:US
Practice Address - Phone:203-366-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPHTHALMIC CONSULTANTS OF CONNECTICUT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002247152W00000X
CT041155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001411553Medicaid
CT004226115Medicaid
CTZ62281Medicare PIN
CT001411553Medicaid
CT180000976Medicare ID - Type UnspecifiedDR JONATHAN STEIN
CT180000909Medicare ID - Type UnspecifiedDR ERIC DONNENFELD