Provider Demographics
NPI:1194771790
Name:NEW HAVEN OPHTHALMOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:NEW HAVEN OPHTHALMOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BERGEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-865-8002
Mailing Address - Street 1:455 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6202
Mailing Address - Country:US
Mailing Address - Phone:203-865-8002
Mailing Address - Fax:
Practice Address - Street 1:455 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6202
Practice Address - Country:US
Practice Address - Phone:203-865-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty