Provider Demographics
NPI:1891919338
Name:DR. THOMAS J. PRIGNANO
Entity Type:Organization
Organization Name:DR. THOMAS J. PRIGNANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-528-5816
Mailing Address - Street 1:893 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2292
Mailing Address - Country:US
Mailing Address - Phone:860-528-5816
Mailing Address - Fax:860-290-5356
Practice Address - Street 1:893 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2292
Practice Address - Country:US
Practice Address - Phone:860-528-5816
Practice Address - Fax:860-290-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2166152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004209905Medicaid
CT004209905Medicaid
CT0308290001Medicare NSC