Provider Demographics
NPI:1801144456
Name:RATCHFORD EYE CENTER LLC
Entity type:Organization
Organization Name:RATCHFORD EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-829-8939
Mailing Address - Street 1:1166 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037
Mailing Address - Country:US
Mailing Address - Phone:860-829-8939
Mailing Address - Fax:860-829-8938
Practice Address - Street 1:1166 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2302
Practice Address - Country:US
Practice Address - Phone:860-829-8939
Practice Address - Fax:860-829-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001722332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier