Provider Demographics
NPI:1740461714
Name:TRAYGIS, PETER F (LO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:F
Last Name:TRAYGIS
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3770
Mailing Address - Country:US
Mailing Address - Phone:860-741-0893
Mailing Address - Fax:860-741-5271
Practice Address - Street 1:90 ELM ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3770
Practice Address - Country:US
Practice Address - Phone:860-741-0893
Practice Address - Fax:860-741-5271
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000667156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0268420001Medicare NSC