Provider Demographics
NPI:1811972243
Name:HORVITZ, A VICTOR (OD)
Entity type:Individual
Prefix:
First Name:A
Middle Name:VICTOR
Last Name:HORVITZ
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:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-0144
Mailing Address - Country:US
Mailing Address - Phone:860-537-2037
Mailing Address - Fax:860-537-4792
Practice Address - Street 1:79C NORWICH AVE
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1261
Practice Address - Country:US
Practice Address - Phone:860-537-2037
Practice Address - Fax:860-537-4792
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT720152W00000X
MA2221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T22468Medicare UPIN