Provider Demographics
NPI:1225638463
Name:SANFILIPPO, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:SANFILIPPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2839
Mailing Address - Country:US
Mailing Address - Phone:860-442-5058
Mailing Address - Fax:860-443-4118
Practice Address - Street 1:131 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2839
Practice Address - Country:US
Practice Address - Phone:860-442-5058
Practice Address - Fax:860-443-4118
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist