Eyedocare,Corp

Primary specialty

OptometristTaxonomy code 152W00000X

License

050644 Issued in CT

Legal business name

EYEDOCARE,CORP

Practice address

500 Westfarms Mall
Farmington, CT 06032-2615

Phone

(860) 674-6053

Fax

(860) 674-6079

NPI assigned

Aug 22, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Guillermo Gallardo, MD

Title

Owner

Phone

(516) 547-6522

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1194124453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 WINSLOW RD",
            "city": "WESTON",
            "state": "CT",
            "postal_code": "068831934",
            "telephone_number": "516-547-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WESTFARMS MALL",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322615",
            "telephone_number": "860-674-6053",
            "fax_number": "860-674-6079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYEDOCARE,CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "GALLARDO",
        "authorized_official_first_name": "GUILLERMO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-547-6522",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CT",
            "license": "050644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008051371",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kristin Ezell, MD
• Tina Fadel, DDS
• Yasser Fadlallah, MD
• Volmir Antonio Faedo Jr., ORTHODONTICS

• Optometrist in Farmington, CT
• Providers in Farmington, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.