Provider Demographics
NPI:1487683470
Name:NEW ENGLAND EYECARE OF MANCHESTER, P.C.
Entity type:Organization
Organization Name:NEW ENGLAND EYECARE OF MANCHESTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-646-6655
Mailing Address - Street 1:397 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4036
Mailing Address - Country:US
Mailing Address - Phone:860-646-6655
Mailing Address - Fax:860-647-7872
Practice Address - Street 1:397 BROAD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4036
Practice Address - Country:US
Practice Address - Phone:860-646-6655
Practice Address - Fax:860-647-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1311680002Medicare NSC
CTC02548Medicare ID - Type Unspecified