Organization
WILD APPLE EYE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS ANTHONY PARADIS OD (OPTOMETRIST)
(860) 577-2012
Entity
Organization
Contact information
Practice address
90 MAIN ST STE 101, CENTERBROOK, CT 06409-1057
(860) 767-3206
Mailing address
54 BOKUM RD, OLD SAYBROOK, CT 06475-1207
(860) 391-3366
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12002152
HARVARD PILGRIM
CT
01
—
139866
CTCARE
CT
01
—
1473930
WELLCARE
—
01
—
4002760
CIGNA
CT
05
—
8073265
—
CT
01
—
A31568
EYEMED
CT
01
—
P5740240
OXFORD
CT
Enumeration date
12/26/2019
Last updated
09/29/2020
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