Provider Demographics
NPI:1528670783
Name:ANTAR, IRENE ELAINE (OD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:ELAINE
Last Name:ANTAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 TURNPIKE SQ
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2758
Mailing Address - Country:US
Mailing Address - Phone:203-878-3098
Mailing Address - Fax:
Practice Address - Street 1:49 TURNPIKE SQ
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2758
Practice Address - Country:US
Practice Address - Phone:203-878-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist