Provider Demographics
NPI:1851661458
Name:SOUTHERN CONNECTICUT EYE CARE PC
Entity Type:Organization
Organization Name:SOUTHERN CONNECTICUT EYE CARE PC
Other - Org Name:NEW ENGLAND EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VARUJAN
Authorized Official - Last Name:KALUSTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-866-5227
Mailing Address - Street 1:280 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1915
Mailing Address - Country:US
Mailing Address - Phone:203-866-5227
Mailing Address - Fax:203-854-9862
Practice Address - Street 1:280 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1915
Practice Address - Country:US
Practice Address - Phone:203-866-5227
Practice Address - Fax:203-854-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008036850Medicaid
CTD100065154Medicare PIN