Provider Demographics
NPI:1700851565
Name:PAVANO, JOSEPH E III (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:PAVANO
Suffix:III
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 1:198 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1915
Mailing Address - Country:US
Mailing Address - Phone:860-223-7900
Mailing Address - Fax:860-826-7161
Practice Address - Street 1:198 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1915
Practice Address - Country:US
Practice Address - Phone:860-223-7900
Practice Address - Fax:860-826-7161
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004119203Medicaid
CTU34902Medicare UPIN
CT004119203Medicaid