Provider Demographics
NPI:1295773893
Name:CONNECTICUT EYE CONSULTANTS, PC
Entity type:Organization
Organization Name:CONNECTICUT EYE CONSULTANTS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FIONA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-791-2020
Mailing Address - Street 1:69 SAND PIT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4004
Mailing Address - Country:US
Mailing Address - Phone:203-791-2020
Mailing Address - Fax:203-778-6238
Practice Address - Street 1:69 SAND PIT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4004
Practice Address - Country:US
Practice Address - Phone:203-791-2020
Practice Address - Fax:203-778-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207WX0200X, 207WX0009X, 207WX0107X, 207WX0110X, 207WX0120X
CT2050391000152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Multi-Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT152W00000XMedicaid
CT207W00000XMedicaid
CT4001327Medicaid
CT4197514Medicaid
CT152W00000XMedicaid