Provider Demographics
NPI:1831107994
Name:SAMSON, HENRY B (OD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:B
Last Name:SAMSON
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 1:100 YORK ST
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5664
Mailing Address - Country:US
Mailing Address - Phone:203-624-3896
Mailing Address - Fax:203-777-2020
Practice Address - Street 1:100 YORK ST
Practice Address - Street 2:SUITE 2K
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5664
Practice Address - Country:US
Practice Address - Phone:203-624-3896
Practice Address - Fax:203-777-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT22-04198OtherUNITED HEALTHCARE
CTOVO398OtherHEALTHNET
CT004024253Medicaid
CT006518OtherCONNECTICARE
CT4143570-002OtherCIGNA
CT090000769CT03OtherANTHEM BLUE CROSS/ BLUE SHIELD
CTOVO398OtherHEALTHNET
CT006518OtherCONNECTICARE
CT22-04198OtherUNITED HEALTHCARE