Provider Demographics
NPI:1578543708
Name:SHAFRAN, SIDNEY LEE (O D)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:LEE
Last Name:SHAFRAN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CROSSROADS LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4517
Mailing Address - Country:US
Mailing Address - Phone:860-404-0328
Mailing Address - Fax:
Practice Address - Street 1:683 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6662
Practice Address - Country:US
Practice Address - Phone:860-583-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT577286OtherCT CARE
CT0V2098OtherHNET
CT906171OtherBLOCK VISON
CT577286OtherCT CARE
CTT23240Medicare UPIN
CT0271690002Medicare NSC