Provider Demographics
NPI:1427427012
Name:ELIAS, YEHUDA EDDIE (LO)
Entity type:Individual
Prefix:MS
First Name:YEHUDA
Middle Name:EDDIE
Last Name:ELIAS
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LONE PINE LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2538
Mailing Address - Country:US
Mailing Address - Phone:203-216-1254
Mailing Address - Fax:
Practice Address - Street 1:2100 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2406
Practice Address - Country:US
Practice Address - Phone:203-281-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001532156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician