Provider Demographics
NPI:1831170596
Name:BROTSKY, CRAIG S (OD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:BROTSKY
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 1:5 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-4105
Mailing Address - Country:US
Mailing Address - Phone:508-381-5600
Mailing Address - Fax:508-381-5610
Practice Address - Street 1:5 WATER ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-4105
Practice Address - Country:US
Practice Address - Phone:508-381-5600
Practice Address - Fax:508-381-5610
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherTRICARE CHAMPUS
4590569OtherAETNA US HEALTHCARE
787403OtherMVP HEALTH CARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
2213091OtherFIRST HEALTH
61208OtherFALLON COMMUNITY HEALTH P
W15740OtherBLUE CARE ELECT
042472266OtherONE HEALTH PLAN
AA2836OtherHARVARD PILGRIM HEALTHCAR
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherTHREE RIVERS
2649494OtherCIGNA PAL ID
60436OtherCHILDRENS MEDICAL SECURIT
416058Medicare ID - Type Unspecified
042472266OtherHEALTHCARE VALUE MANAGEME
2213091OtherFIRST HEALTH
61208OtherFALLON COMMUNITY HEALTH P