Provider Demographics
NPI:1679973820
Name:EYE LIFE VISION LLC
Entity type:Organization
Organization Name:EYE LIFE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-660-2400
Mailing Address - Street 1:1131 WEST ST
Mailing Address - Street 2:BLD 1, SUITE 4
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-6006
Mailing Address - Country:US
Mailing Address - Phone:860-660-2400
Mailing Address - Fax:
Practice Address - Street 1:1131 WEST ST
Practice Address - Street 2:BUILDING 1, SUITE 4
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-6006
Practice Address - Country:US
Practice Address - Phone:860-840-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty