Provider Demographics
NPI:1487278479
Name:CHRISMAN, ALYSSA (OD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S EAST RD STE 7
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2608
Mailing Address - Country:US
Mailing Address - Phone:860-507-0624
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1600 S EAST RD STE 7
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-507-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3638-05152W00000X
CT003220152W00000X
VA0618002969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist