Provider Demographics
NPI:1740259969
Name:SAGNELLA, TONIANN (OD)
Entity type:Individual
Prefix:
First Name:TONIANN
Middle Name:
Last Name:SAGNELLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 FARMINGTON AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1933
Mailing Address - Country:US
Mailing Address - Phone:860-678-0202
Mailing Address - Fax:860-678-0224
Practice Address - Street 1:499 FARMINGTON AVENUE
Practice Address - Street 2:STE 100
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1933
Practice Address - Country:US
Practice Address - Phone:860-678-0202
Practice Address - Fax:860-678-0224
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2265152W00000X
CT002265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004197168Medicaid
CT1073561767Medicaid
CT410000974Medicare PIN