Provider Demographics
NPI:1952519746
Name:AWRUCH, SAMUEL I (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:I
Last Name:AWRUCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WOODHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1854
Mailing Address - Country:US
Mailing Address - Phone:860-561-4189
Mailing Address - Fax:860-561-1206
Practice Address - Street 1:626 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2215
Practice Address - Country:US
Practice Address - Phone:860-529-9222
Practice Address - Fax:860-529-1218
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1067152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22094Medicare UPIN