Provider Demographics
NPI:1720746639
Name:LIGHTHOUSE VISION LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-512-4705
Mailing Address - Street 1:50 CHERRY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3487
Mailing Address - Country:US
Mailing Address - Phone:203-783-9632
Mailing Address - Fax:
Practice Address - Street 1:50 CHERRY ST STE 101
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3487
Practice Address - Country:US
Practice Address - Phone:203-783-9632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty