Provider Demographics
NPI:1396715785
Name:ENFIELD EYECARE ASSOCIATES, L.L.P.
Entity type:Organization
Organization Name:ENFIELD EYECARE ASSOCIATES, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-749-8569
Mailing Address - Street 1:149 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4521
Mailing Address - Country:US
Mailing Address - Phone:860-749-0757
Mailing Address - Fax:860-763-4335
Practice Address - Street 1:149 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4521
Practice Address - Country:US
Practice Address - Phone:860-749-0757
Practice Address - Fax:860-763-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01224Medicare ID - Type Unspecified
CT0331190001Medicare NSC