Provider Demographics
NPI:1689750002
Name:MATUSZEWSKI, PAMELA M (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:M
Last Name:MATUSZEWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:W HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110
Mailing Address - Country:US
Mailing Address - Phone:860-561-0303
Mailing Address - Fax:860-561-8746
Practice Address - Street 1:1445 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:W HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110
Practice Address - Country:US
Practice Address - Phone:860-561-0303
Practice Address - Fax:860-561-8746
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002013CT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090002013CT04OtherBLUE CROSS BLUE SHIELD
CT609404OtherCONNECTICORE
CT609404OtherCONNECTICORE