Provider Demographics
NPI:1487879656
Name:DENIGRIS, MARC (OD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:DENIGRIS
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 1:135 SALTONSTALL PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2426
Mailing Address - Country:US
Mailing Address - Phone:203-467-6112
Mailing Address - Fax:203-469-6424
Practice Address - Street 1:135 SALTONSTALL PKWY
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2426
Practice Address - Country:US
Practice Address - Phone:203-467-6112
Practice Address - Fax:203-469-6424
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410000364Medicare ID - Type Unspecified
T22574Medicare UPIN