Provider Demographics
NPI:1811755564
Name:SCOVEL, JOSIAH DAVID (LO)
Entity type:Individual
Prefix:MR
First Name:JOSIAH
Middle Name:DAVID
Last Name:SCOVEL
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 1:67 JOSEPH CIR
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4059
Mailing Address - Country:US
Mailing Address - Phone:860-301-6806
Mailing Address - Fax:
Practice Address - Street 1:161 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1059
Practice Address - Country:US
Practice Address - Phone:860-635-6221
Practice Address - Fax:860-632-9231
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1820156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician