Provider Demographics
NPI:1487656328
Name:PRICE, CALVIN S (OD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:S
Last Name:PRICE
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 1:502 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4046
Mailing Address - Country:US
Mailing Address - Phone:860-688-5303
Mailing Address - Fax:860-688-5853
Practice Address - Street 1:502 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4046
Practice Address - Country:US
Practice Address - Phone:860-688-5303
Practice Address - Fax:860-688-5853
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004023487Medicaid
CT004023487Medicaid
CT410000189Medicare ID - Type Unspecified