Provider Demographics
NPI:1790730703
Name:RIDGEFIELD FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:RIDGEFIELD FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-438-5855
Mailing Address - Street 1:96 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4069
Mailing Address - Country:US
Mailing Address - Phone:203-438-5855
Mailing Address - Fax:203-431-0318
Practice Address - Street 1:96 DANBURY RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4069
Practice Address - Country:US
Practice Address - Phone:203-438-5855
Practice Address - Fax:203-431-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02686Medicare PIN