Individual
DR. MARCIE LUSTGARTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD LLC
Contact information
Practice address
747 BOSTON POST RD, MADISON, CT 06443-3044
(203) 245-1492
(203) 245-9002
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002226
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004105575
—
CT
01
—
061310883
AETNA
—
01
—
090002226CT01
BCBS OF CT
—
01
—
117603
EYE CARE PLAN OF AMERICA
—
01
—
610883
CONNECTICARE
—
01
—
84069
AETNA
—
01
—
906172
BLOCK VISION
—
01
—
CT02226
VBA
—
01
—
OVO248
HEALTHNET
—
01
—
P00125652
RAILROAD MEDICARE
—
01
—
P377925
OXFORD
—
Enumeration date
01/31/2006
Last updated
02/09/2022
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