Provider Demographics
NPI:1932309382
Name:SOUTHINGTON EYE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:SOUTHINGTON EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHAFIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-621-4412
Mailing Address - Street 1:55 MERIDEN AVE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3238
Mailing Address - Country:US
Mailing Address - Phone:860-621-4412
Mailing Address - Fax:860-276-5262
Practice Address - Street 1:318 NORTH MAIN STREET
Practice Address - Street 2:UNIT 2
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-0648
Practice Address - Country:US
Practice Address - Phone:860-621-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036594207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004191350Medicaid
CTG12248Medicare UPIN
CT004191350Medicaid