Provider Demographics
NPI:1851512917
Name:NORTHERN CONNECTICUT EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTHERN CONNECTICUT EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:HAMI
Authorized Official - Last Name:KHALIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-763-4046
Mailing Address - Street 1:146 HAZARD AVE SUITE 106
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-763-4046
Mailing Address - Fax:860-763-3856
Practice Address - Street 1:146 HAZARD AVE SUITE 106
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-763-4046
Practice Address - Fax:860-763-3856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019793152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001197938Medicaid
CT0789960001Medicare NSC
CTE08487Medicare UPIN