Provider Demographics
NPI:1528280872
Name:BRANFORD OPTOMETRIC ASSOCIATES PC
Entity type:Organization
Organization Name:BRANFORD OPTOMETRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-488-9544
Mailing Address - Street 1:60 MONTOWESE ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3806
Mailing Address - Country:US
Mailing Address - Phone:203-488-9544
Mailing Address - Fax:203-481-2028
Practice Address - Street 1:60 MONTOWESE ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3806
Practice Address - Country:US
Practice Address - Phone:203-488-9544
Practice Address - Fax:203-481-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0135860001OtherDMERC
CT0135860001OtherDMERC
CTU68633Medicare UPIN