Provider Demographics
NPI:1801818802
Name:WINDHAM EYE GROUP P.C.
Entity type:Organization
Organization Name:WINDHAM EYE GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-423-1619
Mailing Address - Street 1:83 QUARRY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-1238
Mailing Address - Country:US
Mailing Address - Phone:860-423-1619
Mailing Address - Fax:860-423-7640
Practice Address - Street 1:83 QUARRY ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1238
Practice Address - Country:US
Practice Address - Phone:860-423-1619
Practice Address - Fax:860-423-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010040216CT01OtherBC/BS WOODS
CT027147OtherCONNECTICARE - PCR
CT24928OtherAETNA PCR HMO & QPOS
CT709097OtherCONNECTICARE -WOODS
CT2747719OtherAETNA WOODS HMO & QPO
CT001271477OtherEDS CATON REARDON
CT004129674OtherEDS GROUP- WEG
CTC14795OtherMEDICARE RR
CT001402164OtherEDS WOODS
CT010027147CT01OtherCATON REARDON
CT090002619CT01OtherBC/BS CLARK
CT090002619CT01OtherBC/BS CLARK
CT2747719OtherAETNA WOODS HMO & QPO
CT027147OtherCONNECTICARE - PCR
CTU90836Medicare UPIN
CT709097OtherCONNECTICARE -WOODS
CT1014220001Medicare NSC