Provider Demographics
NPI:1942200639
Name:PINN, EDWARD F (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:F
Last Name:PINN
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 1:1156 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4405
Mailing Address - Country:US
Mailing Address - Phone:860-388-2020
Mailing Address - Fax:860-388-0889
Practice Address - Street 1:1156 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4405
Practice Address - Country:US
Practice Address - Phone:860-388-2020
Practice Address - Fax:860-388-0889
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004024113Medicaid
CT004024113Medicaid
CT410000242Medicare ID - Type Unspecified