Provider Demographics
NPI:1073652558
Name:ROCK, RICHARD RUSSELL (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RUSSELL
Last Name:ROCK
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 1:97 IRENE DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4005
Mailing Address - Country:US
Mailing Address - Phone:860-872-8717
Mailing Address - Fax:
Practice Address - Street 1:348 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4747
Practice Address - Country:US
Practice Address - Phone:860-870-5800
Practice Address - Fax:860-871-0579
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0745152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT448993OtherCONNETICARE
CTOXFORDOtherP2751756
CT2322856OtherAETNA
CT2322856OtherAETNA