Individual
ROGER S VAN DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4 SHAWS COVE, COASTAL EYE CENTER STE 105, LEW LONDON, CT 06320-4956
(860) 447-8664
(860) 443-2986
Mailing address
4 SHAWS COVE, STE 105, LEW LONDON, CT 06320-4956
(860) 447-8664
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
002816
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010022816CT01
ANTHEM
CT
Enumeration date
07/17/2006
Last updated
07/08/2007
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