Provider Demographics
NPI:1114087855
Name:PIMENTEL, FRANCISCO JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:JOHN
Last Name:PIMENTEL
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 1:582 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3213
Mailing Address - Country:US
Mailing Address - Phone:203-265-6089
Mailing Address - Fax:203-284-8040
Practice Address - Street 1:91 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4203
Practice Address - Country:US
Practice Address - Phone:203-265-5152
Practice Address - Fax:203-265-1562
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000686OtherSTATE LICENSE NUMBER