Provider Demographics
NPI:1497865729
Name:TROCCHI, DOMENICO (OD)
Entity Type:Individual
Prefix:DR
First Name:DOMENICO
Middle Name:
Last Name:TROCCHI
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 1:481 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1247
Mailing Address - Country:US
Mailing Address - Phone:203-753-5665
Mailing Address - Fax:203-757-8886
Practice Address - Street 1:481 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1247
Practice Address - Country:US
Practice Address - Phone:203-753-5665
Practice Address - Fax:203-757-8886
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT-2301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO906159/004753Medicaid
CTC-02265Medicare ID - Type Unspecified
CO906159/004753Medicaid