Provider Demographics
NPI:1881975068
Name:PALMER EYECARE CENTER, LLC
Entity type:Organization
Organization Name:PALMER EYECARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-267-2222
Mailing Address - Street 1:240 MIDDLETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-2120
Mailing Address - Country:US
Mailing Address - Phone:860-346-2020
Mailing Address - Fax:860-267-2210
Practice Address - Street 1:240 MIDDLETOWN AVE
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-2120
Practice Address - Country:US
Practice Address - Phone:860-346-2020
Practice Address - Fax:860-267-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4066965Medicaid
CT4066965Medicaid
0203630001Medicare NSC
410000312Medicare PIN