Provider Demographics
NPI:1659663615
Name:PLAINVILLE OPTOMETRICS LLC
Entity Type:Organization
Organization Name:PLAINVILLE OPTOMETRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-793-9378
Mailing Address - Street 1:28 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2309
Mailing Address - Country:US
Mailing Address - Phone:860-793-9378
Mailing Address - Fax:860-793-2494
Practice Address - Street 1:28 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2309
Practice Address - Country:US
Practice Address - Phone:860-793-9378
Practice Address - Fax:860-793-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT1012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100087794Medicare PIN