Provider Demographics
NPI:1033283197
Name:OPTOMETRIC ASSOCIATES OF DANIELSON PC
Entity Type:Organization
Organization Name:OPTOMETRIC ASSOCIATES OF DANIELSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRANSTON
Authorized Official - Middle Name:ARCHER
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-774-8271
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:419 MAIN ST
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-0488
Mailing Address - Country:US
Mailing Address - Phone:860-774-8271
Mailing Address - Fax:860-774-8279
Practice Address - Street 1:419 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239
Practice Address - Country:US
Practice Address - Phone:860-774-8279
Practice Address - Fax:860-774-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT52868OtherDAVIS VISION
CT41199OtherSPECTARA
CT52868OtherDAVIS VISION