Provider Demographics
NPI:1851565618
Name:COLONY OPTICIANS
Entity Type:Organization
Organization Name:COLONY OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-265-2205
Mailing Address - Street 1:60 CHURCH ST
Mailing Address - Street 2:RT68
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2340
Mailing Address - Country:US
Mailing Address - Phone:203-265-2205
Mailing Address - Fax:203-294-4438
Practice Address - Street 1:60 CHURCH ST
Practice Address - Street 2:RT68
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2340
Practice Address - Country:US
Practice Address - Phone:203-265-2205
Practice Address - Fax:203-294-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2264152W00000X
CT2262152W00000X
CT1278156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty