Provider Demographics
NPI:1265719223
Name:NEW CANAAN OPHTHALMOLOGY LLC
Entity type:Organization
Organization Name:NEW CANAAN OPHTHALMOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-966-6800
Mailing Address - Street 1:11 BURTIS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5532
Mailing Address - Country:US
Mailing Address - Phone:203-966-6800
Mailing Address - Fax:203-966-7721
Practice Address - Street 1:11 BURTIS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5532
Practice Address - Country:US
Practice Address - Phone:203-966-6800
Practice Address - Fax:203-966-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025637207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001256379Medicaid
CT001256379Medicaid