Provider Demographics
NPI:1285621946
Name:TZEPOS, GEORGE Z (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:Z
Last Name:TZEPOS
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 1:25 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3405
Mailing Address - Country:US
Mailing Address - Phone:203-888-9532
Mailing Address - Fax:203-888-1733
Practice Address - Street 1:25 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3405
Practice Address - Country:US
Practice Address - Phone:203-888-9532
Practice Address - Fax:203-888-1733
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004138831Medicaid
CTU43916Medicare UPIN
CT410000796Medicare ID - Type Unspecified