Provider Demographics
NPI:1659337145
Name:ADRIAN, GEORGE DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DENNIS
Last Name:ADRIAN
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 1:1041 POQUONNOCK RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4211
Mailing Address - Country:US
Mailing Address - Phone:860-445-1000
Mailing Address - Fax:860-445-3347
Practice Address - Street 1:1041 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4211
Practice Address - Country:US
Practice Address - Phone:860-445-1000
Practice Address - Fax:860-445-3347
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT1035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1606726OtherTAX ID
CTC02790Medicare ID - Type Unspecified
CTT-22032Medicare UPIN