Organization
SOMERS VISION CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN R SQUILLACE OD (MEMBER)
(860) 763-4733
Entity
Organization
Contact information
Practice address
48 SOUTH RD # 8, SOMERS, CT 06071-2160
(860) 763-4733
(860) 749-6795
Mailing address
PO BOX 801, 48 SOUTH RD #8, SOMERS, CT 06071-0801
(860) 763-4733
(860) 749-6795
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002122
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004243648
—
CT
Enumeration date
12/28/2012
Last updated
12/28/2012
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