Provider Demographics
NPI:1104930619
Name:PULASKI, JOHN JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:PULASKI
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1342
Mailing Address - Country:US
Mailing Address - Phone:203-754-8339
Mailing Address - Fax:203-753-9030
Practice Address - Street 1:625 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1342
Practice Address - Country:US
Practice Address - Phone:203-754-8339
Practice Address - Fax:203-753-9030
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000910152W00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT133167OtherWELLCARE
CT115526OtherEYEMED
CTP379072OtherOXFORD
CT0043160OtherAETNA US HEALTHCARE
CT090000910CT01OtherANTHEM BLUE CROSS
CT762224OtherCONNECTICARE
CTOV8953OtherHEALTHNET
CTT22127Medicare UPIN
CT090000910CT01OtherANTHEM BLUE CROSS