Provider Demographics
NPI:1447438924
Name:NORWICH OPHTHALMOLOGY GROUP, P.C.
Entity type:Organization
Organization Name:NORWICH OPHTHALMOLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISH
Authorized Official - Middle Name:U
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-886-0161
Mailing Address - Street 1:79 WAWECUS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2160
Mailing Address - Country:US
Mailing Address - Phone:860-886-0161
Mailing Address - Fax:860-889-5999
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-886-0161
Practice Address - Fax:860-889-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004394623Medicaid
CTC01450Medicare PIN
CT0231170001Medicare NSC