Organization
EYE DOC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIE MANTELLI OD (OWNER)
(860) 930-9947
Entity
Organization
Contact information
Practice address
371 MAIN ST, STURBRIDGE, MA 01566-1665
(774) 241-0718
Mailing address
20 MESSIER RD, NORTH GROSVENORDALE, CT 06255-2012
(860) 930-9947
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851845713
—
CT
Enumeration date
03/04/2021
Last updated
03/04/2021
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