Provider Demographics
NPI:1952594764
Name:GROTON EYE CENTER, LLC.
Entity Type:Organization
Organization Name:GROTON EYE CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:ADRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-445-1000
Mailing Address - Street 1:456 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4107
Mailing Address - Country:US
Mailing Address - Phone:860-445-1000
Mailing Address - Fax:860-445-4991
Practice Address - Street 1:456 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4107
Practice Address - Country:US
Practice Address - Phone:860-445-1000
Practice Address - Fax:860-445-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02790Medicare UPIN