Provider Demographics
NPI:1003830308
Name:STRAND, MITCHEL BOYD (OD)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:BOYD
Last Name:STRAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2318
Mailing Address - Country:US
Mailing Address - Phone:860-666-7053
Mailing Address - Fax:860-666-7083
Practice Address - Street 1:485 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2318
Practice Address - Country:US
Practice Address - Phone:860-666-7053
Practice Address - Fax:860-666-7083
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004087947Medicaid
CTT78365Medicare UPIN
CT410000778Medicare ID - Type Unspecified
CT004087947Medicaid