| NPI | 1003504705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES DEAN Medical Director 860-928-0414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-08-08 |