Provider Demographics
NPI:1841236122
Name:GERMAIN, ALBERT E (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:E
Last Name:GERMAIN
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 1:1320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3119
Mailing Address - Country:US
Mailing Address - Phone:203-755-4941
Mailing Address - Fax:203-573-8372
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3119
Practice Address - Country:US
Practice Address - Phone:203-755-4941
Practice Address - Fax:203-573-8372
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT896152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090000896CT01OtherBCBS PROVIDER #
CT4318020OtherAETNA PROVIDER #
CT678924OtherCTCARE PROVIDER #
CT004052197Medicaid
CT4611928OtherCIGNA PROVIDER #
CTP377996OtherOXFORD PROVIDER #
CT061078924OtherTAX ID #
CT0R0910OtherHEALTH NET PROVIDER #
CT0R0910OtherHEALTH NET PROVIDER #
CT4318020OtherAETNA PROVIDER #