Provider Demographics
NPI:1992721146
Name:EYE GROUP OF CONNECTICUT, LLC
Entity type:Organization
Organization Name:EYE GROUP OF CONNECTICUT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUNLOP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:203-374-8182
Mailing Address - Street 1:4699 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1830
Mailing Address - Country:US
Mailing Address - Phone:203-374-8182
Mailing Address - Fax:203-374-2626
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1830
Practice Address - Country:US
Practice Address - Phone:203-374-8182
Practice Address - Fax:203-374-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02674Medicare PIN