Provider Demographics
NPI:1992929384
Name:OCULOFACIAL ASSOCIATES OF CONNECTICUT LLC
Entity type:Organization
Organization Name:OCULOFACIAL ASSOCIATES OF CONNECTICUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-452-9723
Mailing Address - Street 1:2 CORPORATE DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1376
Mailing Address - Country:US
Mailing Address - Phone:203-452-9723
Mailing Address - Fax:203-452-9724
Practice Address - Street 1:2 CORPORATE DR
Practice Address - Street 2:SUITE 112
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1376
Practice Address - Country:US
Practice Address - Phone:203-452-9723
Practice Address - Fax:203-452-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022088207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty