Provider Demographics
NPI:1780656579
Name:FAMILY OPTOMETRIC CARE PC
Entity Type:Organization
Organization Name:FAMILY OPTOMETRIC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-243-2508
Mailing Address - Street 1:38 TUNXIS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2034
Mailing Address - Country:US
Mailing Address - Phone:860-243-2508
Mailing Address - Fax:
Practice Address - Street 1:38 TUNXIS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2034
Practice Address - Country:US
Practice Address - Phone:860-243-2508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY OPTOMETRIC CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-06
Last Update Date:2022-10-25
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
CT004163036Medicaid
CTC01299Medicare PIN
CT004163036Medicaid