1790813020 NPI number — HAMDEN EYE ASSOCIATES, P.C

Table of content: (NPI 1790813020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790813020 NPI number — HAMDEN EYE ASSOCIATES, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMDEN EYE ASSOCIATES, P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WALLINGFORD EYE ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790813020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YALESVILLE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06492-2265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-269-3000
Provider Business Mailing Address Fax Number:
203-288-5679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YALESVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06492-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-269-3000
Provider Business Practice Location Address Fax Number:
203-288-5679
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WESTON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-269-3000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6771 . This is a "DAVIS ID" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com