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  7. NPI Record 1801818802

WINDHAM EYE GROUP P.C.
Complete NPI Record 1801818802
Ophthalmology in Willimantic, CT

NPI Status: Active since July 25, 2006

Contact Information

83 QUARRY ST
WILLIMANTIC, CT
ZIP 06226
Phone: (860) 423-1619
Fax: (860) 423-7640

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Middle Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Healthcare Provider Taxonomy Code 2
  29. Healthcare Provider Primary Taxonomy Switch 2
  30. Other Provider Identifier 1
  31. Other Provider Identifier Type Code 1
  32. Other Provider Identifier State 1
  33. Other Provider Identifier Issuer 1
  34. Other Provider Identifier 2
  35. Other Provider Identifier Type Code 2
  36. Other Provider Identifier State 2
  37. Other Provider Identifier Issuer 2
  38. Other Provider Identifier 3
  39. Other Provider Identifier Type Code 3
  40. Other Provider Identifier State 3
  41. Other Provider Identifier Issuer 3
  42. Other Provider Identifier 4
  43. Other Provider Identifier Type Code 4
  44. Other Provider Identifier State 4
  45. Other Provider Identifier Issuer 4
  46. Other Provider Identifier 5
  47. Other Provider Identifier Type Code 5
  48. Other Provider Identifier State 5
  49. Other Provider Identifier Issuer 5
  50. Other Provider Identifier 6
  51. Other Provider Identifier Type Code 6
  52. Other Provider Identifier State 6
  53. Other Provider Identifier Issuer 6
  54. Other Provider Identifier 7
  55. Other Provider Identifier Type Code 7
  56. Other Provider Identifier State 7
  57. Other Provider Identifier Issuer 7
  58. Other Provider Identifier 8
  59. Other Provider Identifier Type Code 8
  60. Other Provider Identifier State 8
  61. Other Provider Identifier Issuer 8
  62. Other Provider Identifier 9
  63. Other Provider Identifier Type Code 9
  64. Other Provider Identifier State 9
  65. Other Provider Identifier Issuer 9
  66. Other Provider Identifier 10
  67. Other Provider Identifier Type Code 10
  68. Other Provider Identifier State 10
  69. Other Provider Identifier Issuer 10
  70. Other Provider Identifier 11
  71. Other Provider Identifier Type Code 11
  72. Other Provider Identifier State 11
  73. Other Provider Identifier Issuer 11
  74. Is Organization Subpart
  75. Authorized Official Name Prefix Text
  76. Authorized Official Credential Text
  77. Healthcare Provider Taxonomy Group 1
  78. Healthcare Provider Taxonomy Group 2

Complete NPI Dataset

This page represents the complete record for NPI 1801818802. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1801818802
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 83 QUARRY ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: WILLIMANTIC
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CT
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 062261238
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 8604231619
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 8604237640
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 83 QUARRY ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WILLIMANTIC
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CT
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 062261238
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8604231619
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8604237640
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 7/25/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/29/2012
The date that a record was last updated or changed.
Authorized Official Last Name: WOODS
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: DANA
The first name of the authorized official.
Authorized Official Middle Name: P
The middle name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 8604231619
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 152W00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 207W00000X
Healthcare Provider Primary Taxonomy Switch 2: Y
Other Provider Identifier 1: 010040216CT01
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: CT
Other Provider Identifier Issuer 1: BC/BS WOODS
Other Provider Identifier 2: 2747719
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: CT
Other Provider Identifier Issuer 2: AETNA WOODS HMO & QPO
Other Provider Identifier 3: C14795
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: CT
Other Provider Identifier Issuer 3: MEDICARE RR
Other Provider Identifier 4: 001402164
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: CT
Other Provider Identifier Issuer 4: EDS WOODS
Other Provider Identifier 5: 709097
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: CT
Other Provider Identifier Issuer 5: CONNECTICARE -WOODS
Other Provider Identifier 6: 24928
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: CT
Other Provider Identifier Issuer 6: AETNA PCR HMO & QPOS
Other Provider Identifier 7: 001271477
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: CT
Other Provider Identifier Issuer 7: EDS CATON REARDON
Other Provider Identifier 8: 010027147CT01
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: CT
Other Provider Identifier Issuer 8: CATON REARDON
Other Provider Identifier 9: 090002619CT01
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: CT
Other Provider Identifier Issuer 9: BC/BS CLARK
Other Provider Identifier 10: 004129674
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: CT
Other Provider Identifier Issuer 10: EDS GROUP- WEG
Other Provider Identifier 11: 027147
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: CT
Other Provider Identifier Issuer 11: CONNECTICARE - PCR
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: M.D.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP