Provider Demographics
NPI:1508934621
Name:COMEAU, JAMES J (LO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:COMEAU
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4112
Mailing Address - Country:US
Mailing Address - Phone:203-265-1541
Mailing Address - Fax:203-265-3129
Practice Address - Street 1:58 CENTER ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4112
Practice Address - Country:US
Practice Address - Phone:203-265-1541
Practice Address - Fax:203-265-3129
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1294156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT51051OtherDAVIS VISION
CTCT1294OtherEYEMED
CT100001294CT02OtherBCBS
CT5373650001Medicare ID - Type Unspecified