1144242082 NPI number — DR. JANICE OCAMPO DOOT O.D.

Table of content: (NPI 1215022520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144242082 NPI number — DR. JANICE OCAMPO DOOT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOOT
Provider First Name:
JANICE
Provider Middle Name:
OCAMPO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OCAMPO
Provider Other First Name:
JANICE-IAN
Provider Other Middle Name:
MANALO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144242082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
882 MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06117-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-523-9998
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 ALBANY TPKE
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06019-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-693-3400
Provider Business Practice Location Address Fax Number:
860-693-3441
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2605 , 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)





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