Provider Demographics
NPI:1891834313
Name:PALOZEJ, DAVID EDWARD
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:PALOZEJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GOOSE LN
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3400
Mailing Address - Country:US
Mailing Address - Phone:860-870-4632
Mailing Address - Fax:870-870-4634
Practice Address - Street 1:12 GOOSE LN
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3400
Practice Address - Country:US
Practice Address - Phone:860-870-4632
Practice Address - Fax:870-870-4634
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004082781Medicaid
CTT22880Medicare UPIN
CT4100001007Medicare PIN