Organization Active NPI

Doctors Eye Clinic, LLC

  • Optometrist
  • Milford, CT
National Provider Identifier
1902221567
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0707 Issued in CT
Legal business name
DOCTORS EYE CLINIC, LLC
Practice address
1201 Boston Post Rd
Sears Optical
Milford, CT 06460-2703
Phone
(203) 494-6628
Fax
(203) 389-2360
NPI assigned
Feb 19, 2014
Last updated
Sep 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2014

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

Authorized official

Name
Dr. Howard Saul Gottlieb, O.D.NPI 1760421259
Title
President
Phone
(203) 494-6628

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0707 CT Primary

Addresses

Primary practice location

1201 Boston Post Rd
Sears Optical
Milford, CT 06460-2703

Mailing address

732 Kyle LN
West Haven, CT 06516-7925
Phone (203) 494-6628

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141204001116 CT Part B Supplier - Clinic/Group Practice 9638491566 Receives reassigned benefits from 3 practitioners
Practice locations: Branford, CT; Lisbon, CT; Waterbury, CT

National Provider Directory

National Provider Directory

Locations

3164 Berlin Tpke
Newington, CT 06111
Phone (860) 667-1302

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411516800000",
    "number": "1902221567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 KYLE LN",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065167925",
            "telephone_number": "203-494-6628",
            "fax_number": "203-389-2360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 BOSTON POST RD",
            "address_2": "SEARS OPTICAL",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064602703",
            "telephone_number": "203-494-6628",
            "fax_number": "203-389-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS EYE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-19",
        "last_updated": "2014-09-24",
        "status": "A",
        "authorized_official_last_name": "GOTTLIEB",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "SAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-494-6628",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "0707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2014; 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.