Provider Demographics
NPI:1629038914
Name:MARCIANO, ANTHONY CHARLES JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:MARCIANO
Suffix:JR
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 1:60 WATERBURY RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1250
Mailing Address - Country:US
Mailing Address - Phone:203-758-5555
Mailing Address - Fax:203-758-6666
Practice Address - Street 1:60 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1250
Practice Address - Country:US
Practice Address - Phone:203-758-5555
Practice Address - Fax:203-758-6666
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004208890Medicaid
CT2380911OtherUS HEALTHCARE
CT2V1329OtherHEALTHNET
CT7484149OtherAETNA
CT0900002543CT02OtherANTHEM BLUE CROSS
CTP2135745OtherOXFORD HEALTH PLANS
CT410043547OtherRAILROAD MEDICARE
CT410043547OtherRAILROAD MEDICARE
CT7484149OtherAETNA