Provider Demographics
NPI:1457505653
Name:EYE MD OF PLAINFIELD LLC
Entity type:Organization
Organization Name:EYE MD OF PLAINFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAMSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TARABISHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-564-4555
Mailing Address - Street 1:50 ACADEMY HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1600
Mailing Address - Country:US
Mailing Address - Phone:860-564-4555
Mailing Address - Fax:860-564-4611
Practice Address - Street 1:50 ACADEMY HILL RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1600
Practice Address - Country:US
Practice Address - Phone:860-564-4555
Practice Address - Fax:860-564-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026332207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01263326Medicaid
CT010026332CT02OtherANTHEM BCBS
CTOV5491OtherHEALTHNET
CT010026332CT02OtherANTHEM BCBS