Provider Demographics
NPI:1659467454
Name:NEW ENGLAND EYECARE OF MANCHESTER, P.C.
Entity Type:Organization
Organization Name:NEW ENGLAND EYECARE OF MANCHESTER, P.C.
Other - Org Name:NEW ENGLAND EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-646-6655
Mailing Address - Street 1:1138 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2413
Mailing Address - Country:US
Mailing Address - Phone:860-236-0896
Mailing Address - Fax:
Practice Address - Street 1:1138 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2413
Practice Address - Country:US
Practice Address - Phone:860-236-0896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2010152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02230Medicare ID - Type UnspecifiedGROUP#