Organization
EYEDOCARE,CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUILLERMO GALLARDO MD (OWNER)
(516) 547-6522
Entity
Organization
Contact information
Practice address
500 WESTFARMS MALL, FARMINGTON, CT 06032-2615
(860) 674-6053
(860) 674-6079
Mailing address
12 WINSLOW RD, WESTON, CT 06883-1934
(516) 547-6522
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
050644
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008051371
—
CT
Enumeration date
08/22/2014
Last updated
02/25/2015
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