Provider Demographics
NPI:1952526147
Name:VISION CENTER
Entity Type:Organization
Organization Name:VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOJCIK
Authorized Official - Suffix:
Authorized Official - Credentials:LO
Authorized Official - Phone:203-488-2082
Mailing Address - Street 1:845 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3413
Mailing Address - Country:US
Mailing Address - Phone:203-488-2082
Mailing Address - Fax:
Practice Address - Street 1:845 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3413
Practice Address - Country:US
Practice Address - Phone:203-488-2082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLO642156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT100000642CT03OtherANTHEM BCBS
CTOP1028OtherEYE MED