Provider Demographics
NPI:1023147428
Name:HIGGINS, DONALD J (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:HIGGINS
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 1:74 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1936
Mailing Address - Country:US
Mailing Address - Phone:860-793-9613
Mailing Address - Fax:860-747-6880
Practice Address - Street 1:74 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1936
Practice Address - Country:US
Practice Address - Phone:860-793-9613
Practice Address - Fax:860-747-6880
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0623670001Medicare ID - Type Unspecified
CTT22059Medicare UPIN