Provider Demographics
NPI:1891985610
Name:COHEN'S FASHION OPTICAL
Entity Type:Organization
Organization Name:COHEN'S FASHION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-856-0705
Mailing Address - Street 1:431 POST ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-454-5558
Mailing Address - Fax:203-221-7051
Practice Address - Street 1:431 POST ROAD EAST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-454-5558
Practice Address - Fax:203-221-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2050305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU58393OtherUPIN
CT2050OtherCT LIC