Provider Demographics
NPI:1114412590
Name:FOLMAN, DAVID JASON (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JASON
Last Name:FOLMAN
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 1:148 EAST AVE STE 3C
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5736
Mailing Address - Country:US
Mailing Address - Phone:203-866-3280
Mailing Address - Fax:203-866-1124
Practice Address - Street 1:148 EAST AVE STE 3C
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5736
Practice Address - Country:US
Practice Address - Phone:203-866-3280
Practice Address - Fax:203-866-1124
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist