Provider Demographics
NPI:1790114866
Name:THE EYE CARE GROUP
Entity Type:Organization
Organization Name:THE EYE CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DULINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-573-4803
Mailing Address - Street 1:1201 WEST MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-573-4803
Mailing Address - Fax:203-573-4805
Practice Address - Street 1:250 INDIAN RIVER ROAD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477
Practice Address - Country:US
Practice Address - Phone:203-597-9100
Practice Address - Fax:203-573-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001610332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790114866Medicare PIN