Provider Demographics
NPI:1679727218
Name:CENTER FOR VISION CARE, LLC
Entity Type:Organization
Organization Name:CENTER FOR VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:IADAROLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-268-7799
Mailing Address - Street 1:535 MONROE TURNPIKE
Mailing Address - Street 2:A-3
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468
Mailing Address - Country:US
Mailing Address - Phone:203-268-7799
Mailing Address - Fax:203-261-3723
Practice Address - Street 1:535 MONROE TPKE
Practice Address - Street 2:A-3
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2382
Practice Address - Country:US
Practice Address - Phone:203-268-7799
Practice Address - Fax:203-261-3723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4137495Medicaid
CT4137495Medicaid