Provider Demographics
NPI:1861488173
Name:FOELLER, PAUL H (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:FOELLER
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:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-0071
Mailing Address - Country:US
Mailing Address - Phone:860-824-5060
Mailing Address - Fax:860-824-9942
Practice Address - Street 1:109 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2463
Practice Address - Country:US
Practice Address - Phone:860-824-5060
Practice Address - Fax:860-824-9942
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2160152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23134Medicare UPIN
CT410000679Medicare ID - Type Unspecified