Provider Demographics
NPI:1649251562
Name:IADAROLA, DENNIS P (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:IADAROLA
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 1:535 MONROE TPKE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2382
Mailing Address - Country:US
Mailing Address - Phone:203-268-7799
Mailing Address - Fax:203-261-3723
Practice Address - Street 1:535 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2382
Practice Address - Country:US
Practice Address - Phone:203-268-7799
Practice Address - Fax:203-261-3723
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004137495Medicaid
U45031Medicare UPIN
CT004137495Medicaid