Provider Demographics
NPI:1295716413
Name:MIDDLESEX EYE PHYSICIANS, P.C.
Entity type:Organization
Organization Name:MIDDLESEX EYE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUSKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-347-7466
Mailing Address - Street 1:400 SAYBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4773
Mailing Address - Country:US
Mailing Address - Phone:860-347-7466
Mailing Address - Fax:860-347-2619
Practice Address - Street 1:400 SAYBROOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4773
Practice Address - Country:US
Practice Address - Phone:860-347-7466
Practice Address - Fax:860-347-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL1733OtherRAILROAD MEDICARE
CT004001632Medicaid
CT004001632Medicaid