Provider Demographics
NPI:1902221567
Name:DOCTORS EYE CLINIC, LLC
Entity Type:Organization
Organization Name:DOCTORS EYE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:SAUL
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-494-6628
Mailing Address - Street 1:732 KYLE LN
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-7925
Mailing Address - Country:US
Mailing Address - Phone:203-494-6628
Mailing Address - Fax:203-389-2360
Practice Address - Street 1:1201 BOSTON POST RD
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2703
Practice Address - Country:US
Practice Address - Phone:203-494-6628
Practice Address - Fax:203-389-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty