Provider Demographics
NPI:1689794851
Name:PTC OPTICAL INC.
Entity Type:Organization
Organization Name:PTC OPTICAL INC.
Other - Org Name:PEARLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED OPTICIAN & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:LO
Authorized Official - Phone:203-877-6593
Mailing Address - Street 1:1330 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2711
Mailing Address - Country:US
Mailing Address - Phone:203-877-6593
Mailing Address - Fax:203-877-9139
Practice Address - Street 1:1330 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2711
Practice Address - Country:US
Practice Address - Phone:203-877-6593
Practice Address - Fax:203-877-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000703156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50PTCOPTICT01OtherANTHEM BCBS OF CT ID#