Provider Demographics
NPI:1699968073
Name:TROCCHI FAMILY OPTOMETRY
Entity type:Organization
Organization Name:TROCCHI FAMILY OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DOMENICO
Authorized Official - Middle Name:
Authorized Official - Last Name:TROCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-753-5665
Mailing Address - Street 1:481 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1247
Mailing Address - Country:US
Mailing Address - Phone:203-757-8886
Mailing Address - Fax:
Practice Address - Street 1:481 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1247
Practice Address - Country:US
Practice Address - Phone:203-757-8886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02265OtherCLINIC NUMBER