1528141983 NPI number — DOCTOR ANTHONY GIOSCIA OPTOMETRIST LLC

Table of content: (NPI 1528141983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528141983 NPI number — DOCTOR ANTHONY GIOSCIA OPTOMETRIST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTOR ANTHONY GIOSCIA OPTOMETRIST LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528141983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
397 COTTAGE GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06002-3119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
397 COTTAGE GROVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06002-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-243-8003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIOSCIA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-763-4895

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2418 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 918245 . This is a "BLOCK VISION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 090002418CT-04 . This is a "ANTHEM BLUE CROSS - BLOOM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 090002418CT-03 . This is a "ANTHEM BLUE CROSS MANCH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 102418 . This is a "CONNECTICUT CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 17448 . This is a "AVESIS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 918043 . This is a "EYEMED" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 50673 . This is a "DAVIS VISION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 09440 . This is a "SPECTERA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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