Provider Demographics
NPI:1790822567
Name:GOUNARIS, ANDREAS C (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:C
Last Name:GOUNARIS
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 1:19 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3729
Mailing Address - Country:US
Mailing Address - Phone:203-740-8926
Mailing Address - Fax:
Practice Address - Street 1:7 BACKUS AVE
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7422
Practice Address - Country:US
Practice Address - Phone:203-798-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090002092CT03OtherANTHEM PROVIDER NUMBER
CTT22794Medicare UPIN