Provider Demographics
NPI:1891902037
Name:CONNECTICUT EYE CONSULTANTS, PC
Entity Type:Organization
Organization Name:CONNECTICUT EYE CONSULTANTS, PC
Other - Org Name:DANBURY EYE PHYSICIANS OPTICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE AND COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FIONA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-791-2020
Mailing Address - Street 1:69 SAND PIT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4004
Mailing Address - Country:US
Mailing Address - Phone:203-792-0090
Mailing Address - Fax:203-778-6238
Practice Address - Street 1:69 SAND PIT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4004
Practice Address - Country:US
Practice Address - Phone:203-792-0090
Practice Address - Fax:203-778-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2050391000152W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4001327Medicaid
CT4197514Medicaid
CT4001327Medicaid
C00695Medicare UPIN