Provider Demographics
NPI:1215065800
Name:EYE MD LLC
Entity type:Organization
Organization Name:EYE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HORNBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-388-1251
Mailing Address - Street 1:48 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1510
Mailing Address - Country:US
Mailing Address - Phone:860-388-1251
Mailing Address - Fax:860-388-1253
Practice Address - Street 1:48 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1510
Practice Address - Country:US
Practice Address - Phone:860-388-1251
Practice Address - Fax:860-388-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001261650Medicaid
CTP523114OtherOXFORD
CT561020OtherAETNA
CT010026165CT01OtherANTHEM BCBS
CT026165OtherCONNECTICARE
CTOVO462OtherHEALTH NET
CT5934040001Medicare NSC
CTP523114OtherOXFORD