Provider Demographics
NPI:1982104535
Name:INSTITUTE FOR INTEGRATED VISION, LLC
Entity Type:Organization
Organization Name:INSTITUTE FOR INTEGRATED VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-357-0204
Mailing Address - Street 1:1425 BEDFORD ST STE 1M
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5203
Mailing Address - Country:US
Mailing Address - Phone:203-357-0204
Mailing Address - Fax:203-348-0230
Practice Address - Street 1:1425 BEDFORD ST STE 1M
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5203
Practice Address - Country:US
Practice Address - Phone:203-357-0204
Practice Address - Fax:203-348-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2299152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1144750035Medicaid
CT1316469133Medicaid
CT1144293317Medicaid
CT1326265562Medicaid