Provider Demographics
NPI:1659419620
Name:ORLEN, JOSHUA ELI (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ELI
Last Name:ORLEN
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 1:4 GRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3204
Mailing Address - Country:US
Mailing Address - Phone:413-387-7276
Mailing Address - Fax:
Practice Address - Street 1:90 ELM ST STE 27
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3724
Practice Address - Country:US
Practice Address - Phone:413-387-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U90651Medicare UPIN