Provider Demographics
NPI:1063503613
Name:DUFFY, THOMAS MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MITCHELL
Last Name:DUFFY
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 1:336 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-2303
Mailing Address - Country:US
Mailing Address - Phone:203-732-3937
Mailing Address - Fax:203-735-0805
Practice Address - Street 1:336 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2303
Practice Address - Country:US
Practice Address - Phone:203-732-3937
Practice Address - Fax:203-735-0805
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410001056Medicare ID - Type Unspecified
CTT21998Medicare UPIN