NPIMap

Organization Active NPI

Eye Disease Consultants, LLC

  • Ophthalmology Physician
  • West Hartford, CT
National Provider Identifier
1487621819
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
041429 Issued in CT
Legal business name
EYE DISEASE CONSULTANTS, LLC
Practice address
1043 Farmington Ave
West Hartford, CT 06107-2110
Phone
(860) 549-2020
Fax
(860) 549-2025
NPI assigned
Mar 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Paul Anton Gaudio, M.D.NPI 1942271895
Title
Managing Partner
Phone
(860) 549-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 002692 CT
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 041429 CT Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 011792 CT
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207WX0107X 011792 CT
Uveitis and Ocular Inflammatory Disease (Ophthalmology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207WX0108X 041429 CT
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

1043 Farmington Ave
West Hartford, CT 06107-2110

Mailing address

1043 Farmington Ave
West Hartford, CT 06107-2110
Phone (860) 549-2020

Other practice location 1

85 Seymour St
Suite 522
Hartford, CT 06106-5501
Phone (860) 549-2020

Other identifiers 2

IdentifierTypeStateIssuer
9736841MedicaidMA
004242492MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040203000369 CT Part B Supplier - Clinic/Group Practice 3870486079 Receives reassigned benefits from 5 practitioners
Practice locations: West Hartford, CT

National Provider Directory

National Provider Directory

Locations

85 Seymour St
Ste 522
Hartford, CT 06106
Phone (860) 527-6473

85 Seymour St
Ste 507
Hartford, CT 06106
Phone (860) 548-1383

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1487621819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072110",
            "telephone_number": "860-549-2020",
            "fax_number": "860-549-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072110",
            "telephone_number": "860-549-2020",
            "fax_number": "860-549-2025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "85 Seymour St",
            "address_2": "Suite 522",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061065501",
            "country_code": "US",
            "telephone_number": "860-549-2020",
            "fax_number": "860-549-2025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EYE DISEASE CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GAUDIO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "ANTON",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "860-549-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CT",
            "license": "002692",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "041429",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "011792",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "CT",
            "license": "011792",
            "primary": false
        },
        {
            "code": "207WX0108X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology, Uveitis and Ocular Inflammatory Disease",
            "state": "CT",
            "license": "041429",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9736841",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004242492",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.