Provider Demographics
NPI:1407041593
Name:D'ANGELO & PESCE
Entity Type:Organization
Organization Name:D'ANGELO & PESCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-482-4439
Mailing Address - Street 1:373 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-5050
Mailing Address - Country:US
Mailing Address - Phone:860-482-4439
Mailing Address - Fax:860-482-8242
Practice Address - Street 1:373 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5050
Practice Address - Country:US
Practice Address - Phone:860-482-4439
Practice Address - Fax:860-482-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1234Medicare UPIN