Provider Demographics
NPI:1366948150
Name:DELLA PORTA EYECARE, LLC
Entity type:Organization
Organization Name:DELLA PORTA EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLA PORTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-919-5321
Mailing Address - Street 1:156 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4218
Mailing Address - Country:US
Mailing Address - Phone:860-582-0702
Mailing Address - Fax:860-314-0263
Practice Address - Street 1:156 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4218
Practice Address - Country:US
Practice Address - Phone:860-582-0702
Practice Address - Fax:860-314-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty