Provider Demographics
NPI:1285608687
Name:REGONINI, ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:REGONINI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 MEMORIAL DR
Mailing Address - Street 2:STE B
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-3958
Mailing Address - Country:US
Mailing Address - Phone:413-593-3101
Mailing Address - Fax:413-593-3114
Practice Address - Street 1:1176 MEMORIAL DR
Practice Address - Street 2:STE B
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-3958
Practice Address - Country:US
Practice Address - Phone:413-593-3101
Practice Address - Fax:413-593-3114
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA561543OtherUS HEALTHCARE
MA7293579OtherCIGNA
MA0335487Medicaid
15835OtherHEALTH NEW ENGLAND
MA561543OtherAETNA
MAW15398OtherBLUE CROSS/BLUE SHIELD
MA000000029813OtherBOSTON MEDICAL CENTER
MA760862OtherTUFTS
MA796816OtherCT CARE
MA561543OtherUS HEALTHCARE
MA173758Medicare UPIN