Provider Demographics
NPI:1487869442
Name:COLCHESTER EYE CARE, LLC
Entity type:Organization
Organization Name:COLCHESTER EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-228-1719
Mailing Address - Street 1:163 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1022
Mailing Address - Country:US
Mailing Address - Phone:860-537-2020
Mailing Address - Fax:
Practice Address - Street 1:163 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1022
Practice Address - Country:US
Practice Address - Phone:860-537-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-13
Last Update Date:2019-03-09
Deactivation Date:2018-08-06
Deactivation Code:
Reactivation Date:2019-03-09
Provider Licenses
StateLicense IDTaxonomies
CT002318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02840Medicare PIN