Somers Vision Clinic, LLC
Organization Active NPI Optometrist · Somers, CT
NPI 1295071934 · NPPES record last updated Dec 28, 2012
Key facts
- NPI
- 1295071934
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 002122 (CT)
- Legal business name
- SOMERS VISION CLINIC, LLC
- Practice address
- 48 South Rd # 8
Somers, CT 06071-2160 - Phone
- (860) 763-4733
- Fax
- (860) 749-6795
- NPI assigned
- Dec 28, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Steven R Squillace, OD
- Title
- Member
- Phone
- (860) 763-4733
Practitioners 1
-
Steven Richard Squillace, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D2301297 | Somers Vision Clinic, LLC | Certificate of waiver | Mar 24, 2028 |
National Provider Directory
Locations
48 South Rd
Unit 8
Somers, CT 06071
Phone (860) 763-4733
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 002122 | CT | Yes |
Addresses
Primary practice location
48 South Rd # 8
Somers, CT 06071-2160
Mailing address
PO Box 801
48 South Rd #8
Somers, CT 06071-0801
Phone (860) 763-4733
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004243648 | Medicaid | CT |
Other providers in Somers, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.