Connecticut Eye Physicians and Surgeons LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

035387 Issued in CT

Legal business name

CONNECTICUT EYE PHYSICIANS AND SURGEONS LLC

Practice address

479 Buckland Rd
South Windsor, CT 06074-3739

Phone

(860) 644-5011

Fax

(860) 644-4833

NPI assigned

Aug 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Richard J Manganiello, M.D.NPI 1003881764

Title

Owner;/Provider

Phone

(860) 644-5011

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

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

• Richard John Manganiello, M.D.

  • Ophthalmology Physician
  • South Windsor, CT
  • NPI 1003881764

  CT

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1760675409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "479 BUCKLAND RD STE A",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060743739",
            "telephone_number": "860-644-5011",
            "fax_number": "860-644-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "479 BUCKLAND RD",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060743739",
            "telephone_number": "860-644-5011",
            "fax_number": "860-644-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT EYE PHYSICIANS AND SURGEONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "MANGANIELLO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER;/PROVIDER",
        "authorized_official_telephone_number": "860-644-5011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "035387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001353870",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in South Windsor, CT
• Ophthalmology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.