Provider Demographics
NPI:1972647360
Name:ROGER HIRONS OD LLC
Entity Type:Organization
Organization Name:ROGER HIRONS OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-633-8114
Mailing Address - Street 1:1 HORIZON LN
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2829
Mailing Address - Country:US
Mailing Address - Phone:860-633-8114
Mailing Address - Fax:
Practice Address - Street 1:24 KANE ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2109
Practice Address - Country:US
Practice Address - Phone:860-233-8548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02808Medicare ID - Type Unspecified