Provider Demographics
NPI:1629687835
Name:GIETZEN, DAMIEN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:JOSEPH
Last Name:GIETZEN
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 1:121 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4165
Mailing Address - Country:US
Mailing Address - Phone:508-818-8667
Mailing Address - Fax:
Practice Address - Street 1:37 SOUNDVIEW RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2916
Practice Address - Country:US
Practice Address - Phone:203-453-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003155152WL0500X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy