Provider Demographics
NPI:1578544532
Name:BOCCUZZI, JAMES L (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:BOCCUZZI
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 1:25 GREEN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-3509
Mailing Address - Country:US
Mailing Address - Phone:860-779-1588
Mailing Address - Fax:860-779-1754
Practice Address - Street 1:25 GREEN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3509
Practice Address - Country:US
Practice Address - Phone:860-779-1588
Practice Address - Fax:860-779-1754
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T22338Medicare UPIN
CT410000906Medicare PIN