Provider Demographics
NPI:1770654584
Name:ELGART & PINN OPTOMETRISTS, P.C.
Entity Type:Organization
Organization Name:ELGART & PINN OPTOMETRISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-388-2020
Mailing Address - Street 1:1156 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4405
Mailing Address - Country:US
Mailing Address - Phone:860-388-2020
Mailing Address - Fax:860-388-0889
Practice Address - Street 1:1156 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4405
Practice Address - Country:US
Practice Address - Phone:860-388-2020
Practice Address - Fax:860-388-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0462220001Medicare NSC
CTC00403Medicare PIN