Provider Demographics
NPI:1700105145
Name:DR THOMAS J DELUCA AND DR ANTHONY C MARCIANO AND ASSOCIATES P C
Entity Type:Organization
Organization Name:DR THOMAS J DELUCA AND DR ANTHONY C MARCIANO AND ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MARCIANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:203-758-4447
Mailing Address - Street 1:PO BOX 7015
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-0015
Mailing Address - Country:US
Mailing Address - Phone:203-758-4447
Mailing Address - Fax:
Practice Address - Street 1:67 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1218
Practice Address - Country:US
Practice Address - Phone:203-758-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2543152W00000X
CTCT784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT731890OtherCONNECTICARE
CT004208890Medicaid
CT090000688CT02OtherBLUE CROSS BLUE SHIELD FEP
CT090000784CT01OtherANTHEM BLUE CROSS BLUE SHIELD
CT410014504OtherRAILROAD MEDICARE
CT7760933012OtherCONNECTICARE
CTP2391686OtherOXFORD HEALTH PLANS
CT004024378Medicaid
CT090000688CT02OtherBLUE CROSS FEP
CT0V8126OtherHEALTHNET
CT0V0487OtherHEALTHNET
CT2380911OtherAETNA
CT410043547OtherRAILROAD MEDICARE
CT0502410001OtherDME MAC JURISDICTION A
CT090002543CT03OtherANTHEM BLUE CROSS BLUE SHIELD
CTP384390OtherOXFORD HEALTH PLANS
CT410043547OtherRAILROAD MEDICARE
CT410000262Medicare PIN