Provider Demographics
NPI:1174661771
Name:AMATUZZI, GEORGE GIOVANNI (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GIOVANNI
Last Name:AMATUZZI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DEANNA
Other - Middle Name:JOY
Other - Last Name:MAGGUILLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:419 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4513
Mailing Address - Country:US
Mailing Address - Phone:203-431-3937
Mailing Address - Fax:
Practice Address - Street 1:419 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4513
Practice Address - Country:US
Practice Address - Phone:203-431-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT002514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03009Medicare PIN