Crystal Vision, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

CRYSTAL VISION, LLC

Doing business as

Pearle Vision

Practice address

909 Hartford Tpke
Waterford, CT 06385-4267

Phone

(860) 442-0380

Fax

(860) 442-0831

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Brian Geoffrey Mann, O.D.NPI 1942301858

Title

Owner

Phone

(860) 442-0380

Specialties & licenses 5

Addresses

Other names 1

• Pearle Vision Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 5

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

• Brian G Mann, OD

  • Optometrist
  • Waterford, CT
  • NPI 1942301858
  Medicare reassignment Care Compare group Authorized official
• Kathryn H Bony, OD

  • Optometrist
  • Norwich, CT
  • NPI 1013997923
  Medicare reassignment Care Compare group NPD
• Evelyn Yee-Lam Wong, OD

  • Optometrist
  • Waterford, CT
  • NPI 1407426828
  Medicare reassignment Care Compare group NPD
• John Loucopoulos, OD

  • Optometrist
  • Milford, CT
  • NPI 1861457814
  NPD (past)
• Diane Zou

  • Optometrist
  • Waterford, CT
  • NPI 1609700962
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229472000000",
    "number": "1760556393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 HARTFORD TPKE",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063854267",
            "telephone_number": "860-442-0380",
            "fax_number": "860-442-0831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 HARTFORD TPKE",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063854267",
            "telephone_number": "860-442-0380",
            "fax_number": "860-442-0831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL VISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2008-12-17",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "GEOFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-442-0380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearle Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; 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.