Provider Demographics
NPI:1043664006
Name:COMPLETE EYECARE, LLC
Entity type:Organization
Organization Name:COMPLETE EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:OHLIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-321-9597
Mailing Address - Street 1:650 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1126
Mailing Address - Country:US
Mailing Address - Phone:203-321-9597
Mailing Address - Fax:203-939-1410
Practice Address - Street 1:650 MAIN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1126
Practice Address - Country:US
Practice Address - Phone:203-321-9597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008053302Medicaid