Provider Demographics
NPI:1942487327
Name:SEYMOUR OPTOMETRIC CENTER, LLC
Entity Type:Organization
Organization Name:SEYMOUR OPTOMETRIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ZOIS
Authorized Official - Last Name:TZEPOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-888-9532
Mailing Address - Street 1:25 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3405
Mailing Address - Country:US
Mailing Address - Phone:203-888-9532
Mailing Address - Fax:
Practice Address - Street 1:25 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3405
Practice Address - Country:US
Practice Address - Phone:203-888-9532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1082320001Medicare NSC