Provider Demographics
NPI:1386747962
Name:RIBEIRO OPTICIANS INC
Entity type:Organization
Organization Name:RIBEIRO OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIBEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:LICENCED OPTICIAN
Authorized Official - Phone:203-574-3095
Mailing Address - Street 1:190 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1909
Mailing Address - Country:US
Mailing Address - Phone:203-574-3095
Mailing Address - Fax:203-574-3095
Practice Address - Street 1:190 GRAND ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1909
Practice Address - Country:US
Practice Address - Phone:203-574-3095
Practice Address - Fax:203-574-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001240156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0125340001Medicare ID - Type Unspecified