Provider Demographics
NPI:1154174589
Name:WATERFORD OPTOMETRIC PC
Entity type:Organization
Organization Name:WATERFORD OPTOMETRIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-698-1292
Mailing Address - Street 1:903 HARTFORD TPKE UNIT 29
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4264
Mailing Address - Country:US
Mailing Address - Phone:917-698-1292
Mailing Address - Fax:
Practice Address - Street 1:903 HARTFORD TPKE UNIT 29
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4264
Practice Address - Country:US
Practice Address - Phone:917-698-1292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty