Provider Demographics
NPI:1669402913
Name:CONNORS, ROBERT ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:CONNORS
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 1:464 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2626
Mailing Address - Country:US
Mailing Address - Phone:203-879-6444
Mailing Address - Fax:203-879-4290
Practice Address - Street 1:464 WOLCOTT ROAD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716
Practice Address - Country:US
Practice Address - Phone:203-879-6444
Practice Address - Fax:203-879-4290
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004048237Medicaid
CTT22048Medicare UPIN
CT004048237Medicaid
CT0474220001Medicare NSC