Provider Demographics
NPI:1427649128
Name:NORWICH OPHTHALMOLOGY GROUP, P.C.
Entity type:Organization
Organization Name:NORWICH OPHTHALMOLOGY GROUP, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISH
Authorized Official - Middle Name:U
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-886-0161
Mailing Address - Street 1:79 WAWECUS ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2178
Mailing Address - Country:US
Mailing Address - Phone:860-886-0161
Mailing Address - Fax:860-889-5999
Practice Address - Street 1:489 GOLD STAR HWY STE 100
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6227
Practice Address - Country:US
Practice Address - Phone:860-445-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORWICH OPHTHALMOLOGY GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-27
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier