Provider Demographics
NPI:1649241647
Name:PRIGNANO, THOMAS J (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:PRIGNANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:893 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2292
Mailing Address - Country:US
Mailing Address - Phone:860-528-5816
Mailing Address - Fax:860-290-5356
Practice Address - Street 1:893 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2292
Practice Address - Country:US
Practice Address - Phone:860-528-5816
Practice Address - Fax:860-290-5356
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2166152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004209905Medicaid
CT061313539OtherCT TAX ID
CT061313539OtherCT TAX ID
CTC02703Medicare ID - Type Unspecified