Provider Demographics
NPI:1790739233
Name:TOTALVISION EYECARE CENTER OF GLASTONBURY,LLC
Entity Type:Organization
Organization Name:TOTALVISION EYECARE CENTER OF GLASTONBURY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-659-5900
Mailing Address - Street 1:63 HEBRON AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2078
Mailing Address - Country:US
Mailing Address - Phone:860-659-5900
Mailing Address - Fax:860-659-9900
Practice Address - Street 1:63 HEBRON AVENUE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2078
Practice Address - Country:US
Practice Address - Phone:860-659-5900
Practice Address - Fax:860-659-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2023152W00000X
CT969152W00000X
CT0969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22397Medicare UPIN
CT410000786Medicare ID - Type Unspecified
410000879Medicare PIN
T22912Medicare UPIN
CTT22912Medicare UPIN