Provider Demographics
NPI:1265619845
Name:HENRY B SAMSON
Entity type:Organization
Organization Name:HENRY B SAMSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-624-3896
Mailing Address - Street 1:100 YORK ST
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5620
Mailing Address - Country:US
Mailing Address - Phone:203-624-3896
Mailing Address - Fax:
Practice Address - Street 1:100 YORK ST
Practice Address - Street 2:SUITE 2K
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5620
Practice Address - Country:US
Practice Address - Phone:203-624-3896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090000769CT02OtherANTHEM BC/BS
CT006518OtherCONNECTICARE
CT0206420001OtherMEDICARE DMERC
CTOVO398OtherHEALTHNET
4143570-002OtherCIGNA
CTT22472Medicare UPIN