Provider Demographics
NPI:1487621819
Name:EYE DISEASE CONSULTANTS, LLC
Entity type:Organization
Organization Name:EYE DISEASE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:GAUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-549-2020
Mailing Address - Street 1:1043 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2110
Mailing Address - Country:US
Mailing Address - Phone:860-549-2020
Mailing Address - Fax:860-549-2025
Practice Address - Street 1:1043 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2110
Practice Address - Country:US
Practice Address - Phone:860-549-2020
Practice Address - Fax:860-549-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041429207WX0108X, 207W00000X
335E00000X
CT002692152W00000X
CT011792207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory DiseaseGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9736841Medicaid
CT004242492Medicaid
MA9736841Medicaid