Provider Demographics
NPI:1790910032
Name:TOTALVISION EYECARE CENTER OF MANCHESTER, PC
Entity Type:Organization
Organization Name:TOTALVISION EYECARE CENTER OF MANCHESTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:ALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-649-3311
Mailing Address - Street 1:362 MIDDLE TPKE W
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3824
Mailing Address - Country:US
Mailing Address - Phone:860-649-3311
Mailing Address - Fax:860-533-1960
Practice Address - Street 1:362 MIDDLE TPKE W
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3824
Practice Address - Country:US
Practice Address - Phone:860-649-3311
Practice Address - Fax:860-533-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22397Medicare UPIN
CT410000786Medicare PIN