Provider Demographics
NPI:1972275394
Name:BIANCAMANO, DONALD (LO)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:BIANCAMANO
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 GOLD STAR HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6227
Mailing Address - Country:US
Mailing Address - Phone:860-445-2461
Mailing Address - Fax:860-445-8512
Practice Address - Street 1:489 GOLD STAR HWY STE 100
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6227
Practice Address - Country:US
Practice Address - Phone:860-445-2461
Practice Address - Fax:860-445-8512
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000755156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician