Provider Demographics
NPI:1336112770
Name:MADRAK, JOSEPH S (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:MADRAK
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 1:7 RIVERSIDE DR
Mailing Address - Street 2:# 4
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-8164
Mailing Address - Country:US
Mailing Address - Phone:203-924-2175
Mailing Address - Fax:203-924-9232
Practice Address - Street 1:7 RIVERSIDE DR
Practice Address - Street 2:# 4
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-8164
Practice Address - Country:US
Practice Address - Phone:203-924-2175
Practice Address - Fax:203-924-9232
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006965-1152W00000X
CT002692152WC0802X, 152WL0500X, 335E00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008035624Medicaid
CT008035624Medicaid