Provider Demographics
NPI:1871655951
Name:OPHTHALMIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:OPHTHALMIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PULICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-378-3224
Mailing Address - Street 1:160 HAWLEY LN
Mailing Address - Street 2:STE 107
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5300
Mailing Address - Country:US
Mailing Address - Phone:203-378-3224
Mailing Address - Fax:203-378-2968
Practice Address - Street 1:160 HAWLEY LN
Practice Address - Street 2:STE 107
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5300
Practice Address - Country:US
Practice Address - Phone:203-378-3224
Practice Address - Fax:203-378-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004001707Medicaid
CTC00593Medicare PIN
CT004001707Medicaid