Provider Demographics
NPI:1457551426
Name:MORRISSEY, PETER H
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:H
Last Name:MORRISSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WESTFARMS MALL
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2631
Mailing Address - Country:US
Mailing Address - Phone:860-561-2202
Mailing Address - Fax:860-521-8258
Practice Address - Street 1:61 WESTFARMS MALL
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2631
Practice Address - Country:US
Practice Address - Phone:860-561-2202
Practice Address - Fax:860-521-8258
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1287156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician