Provider Demographics
NPI:1912022971
Name:SANTANELLI, JAMES PASQUALE (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PASQUALE
Last Name:SANTANELLI
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 1:184 GARVIN RD.
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1406
Mailing Address - Country:US
Mailing Address - Phone:203-248-9426
Mailing Address - Fax:203-248-9426
Practice Address - Street 1:184 GARVIN RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-1406
Practice Address - Country:US
Practice Address - Phone:203-248-9426
Practice Address - Fax:203-248-9426
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090000912CT01OtherANTHEM BLUE CROSS
CTCT0314OtherEYEMED
CT702999OtherCONNECTICARE
CT2V8791OtherHEALTH NET
CT3841287OtherAETNA
CTT22508Medicare UPIN