Provider Demographics
NPI:1356692214
Name:COMPLETE FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:COMPLETE FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-644-1912
Mailing Address - Street 1:46 ELLSWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2368
Mailing Address - Country:US
Mailing Address - Phone:860-644-1912
Mailing Address - Fax:
Practice Address - Street 1:238G TOLLAND TPKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-5706
Practice Address - Country:US
Practice Address - Phone:860-281-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU81532Medicare UPIN