Provider Demographics
NPI:1649504432
Name:PRUDHOMME VISION LLC
Entity type:Organization
Organization Name:PRUDHOMME VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:PRUDHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-448-9295
Mailing Address - Street 1:12 NOTTINGHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1185
Mailing Address - Country:US
Mailing Address - Phone:617-448-9295
Mailing Address - Fax:
Practice Address - Street 1:194 BUCKLAND HILLS DR
Practice Address - Street 2:SUITE 1106
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8705
Practice Address - Country:US
Practice Address - Phone:860-233-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT002725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty