Provider Demographics
NPI:1861484081
Name:JOEL, DAVID W (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:JOEL
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 1:130 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1405
Mailing Address - Country:US
Mailing Address - Phone:203-397-3878
Mailing Address - Fax:203-397-9110
Practice Address - Street 1:130 AMITY RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1405
Practice Address - Country:US
Practice Address - Phone:203-397-3878
Practice Address - Fax:203-397-9110
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2008-08-21
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CT948152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004101218Medicaid
CT410000509Medicare ID - Type Unspecified
CT004101218Medicaid
CTT23454Medicare UPIN