Organization
SURGICAL AND MEDICAL OPHTHAMOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARMEN VEGA (MANAGER)
(860) 646-4083
Entity
Organization
Contact information
Practice address
295 E CENTER ST, MANCHESTER, CT 06040-5211
(860) 646-4083
(860) 647-1733
Mailing address
295 E CENTER ST, MANCHESTER, CT 06040-5211
(860) 646-4083
(860) 647-1733
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
027201
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001272012
—
CT
Enumeration date
06/27/2014
Last updated
07/01/2014
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