Provider Demographics
NPI:1952353989
Name:LOVELAND EYECARE, LLC
Entity Type:Organization
Organization Name:LOVELAND EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-635-3300
Mailing Address - Street 1:6 SCOTT LN
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1235
Mailing Address - Country:US
Mailing Address - Phone:860-632-8270
Mailing Address - Fax:
Practice Address - Street 1:28 SHUNPIKE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2454
Practice Address - Country:US
Practice Address - Phone:860-635-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004118023Medicaid
CT410000586Medicare ID - Type Unspecified