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Organization

CONNECTICUT RETINA CONSULTANTS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WAYNE IAN LARRISON M.D. (PARTNER/PHYSICIAN)
(203) 787-6161
Entity
Organization

Contact information

Practice address
46 PRINCE STREET, SUITE 203, NEW HAVEN, CT 06519-1600
(203) 787-6161
(203) 776-0300
Mailing address
46 PRINCE STREET, SUITE 203, NEW HAVEN, CT 06519-1600
(203) 787-6161
(203) 776-0300

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
03754
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001307546
CT
05
001337303
CT
05
001367300
CT
05
004203163
CT
01
180040406
RAILROAD MEDICARE
CT
01
180040407
RAILROAD MEDICARE
CT
01
180042135
RAILROAD MEDICARE
CT
01
CH2721
RAILROAD MEDICARE
CT
01
P00412496
MEDICARE RAIL ROAD
CT
Enumeration date
03/26/2007
Last updated
09/08/2023
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