Organization
LASER AND VISION SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW CASTALDI (CHIEF COMPLIANCE OFFICER)
(860) 643-3900
Entity
Organization
Contact information
Practice address
178 HARTFORD RD, MANCHESTER, CT 06040-5986
(860) 649-9973
Mailing address
178 HARTFORD RD, MANCHESTER, CT 06040-5986
(860) 649-9973
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0163
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004207032
MEDICAID
CT
01
—
117819
EYEMED
CT
01
—
17402
SPECTRA
CT
01
—
20472
COLE MANAGED
CT
01
—
2380780
AETNA
CT
01
—
352
ANTHEM
CT
01
—
490004322
RAILROAD MEDICARE
CT
01
—
774128
CONNECTICARE
CT
01
—
A2021364
OXFORD
CT
01
—
IV7858
HEALTH NET
CT
Enumeration date
05/15/2007
Last updated
09/09/2021
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