Individual
DR. THOMAS PAUL MISIEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
25 NORTH MAIN STREET, ENFIELD, CT 06082-1289
(860) 745-8055
(860) 745-2355
Mailing address
PO BOX 1289, ENFIELD, CT 06083-1289
(860) 745-8055
(860) 745-2355
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
000971
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005971059
AETNA
TX
01
—
0519191
AETNA
—
01
—
0596650001
MEDICARE MATERIALS
—
01
—
09000971CT01
ANTHEM BCBS
CT
01
—
11220239
CAQH
—
01
—
738255
CONNECTICARE
CT
01
—
UPIN 27681
VISION SERVICE PLAN
—
Enumeration date
01/16/2007
Last updated
07/09/2007
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