Provider Demographics
NPI:1447327127
Name:TOTALVISION EYE HEALTH CENTER LLC
Entity type:Organization
Organization Name:TOTALVISION EYE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:STRAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-666-7053
Mailing Address - Street 1:2020 NORWICH NEW LONDON TPKE
Mailing Address - Street 2:UNIT 8
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1374
Mailing Address - Country:US
Mailing Address - Phone:860-848-8777
Mailing Address - Fax:860-848-3388
Practice Address - Street 1:2020 NORWICH NEW LONDON TPKE
Practice Address - Street 2:UNIT 8
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1374
Practice Address - Country:US
Practice Address - Phone:860-848-8777
Practice Address - Fax:860-848-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004097764Medicaid
CT004097764Medicaid
CT0174890003Medicare NSC