Provider Demographics
NPI:1821261801
Name:STAMFORD VISION CARE.LLC
Entity Type:Organization
Organization Name:STAMFORD VISION CARE.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DECARLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-327-1511
Mailing Address - Street 1:526 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3746
Mailing Address - Country:US
Mailing Address - Phone:203-327-1511
Mailing Address - Fax:203-325-4479
Practice Address - Street 1:526 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3746
Practice Address - Country:US
Practice Address - Phone:203-327-1511
Practice Address - Fax:203-325-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT704152W00000X
CT2021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4653930001OtherDME
CT124217OtherUNITED HEALTHCARE
CT090000704CT01OtherANTHEM
CT124217OtherUNITED HEALTHCARE
CT4653930001OtherDME
CT090000704CT01OtherANTHEM
CTT23368Medicare UPIN
CT4653930001Medicare NSC