Provider Demographics
NPI:1447321146
Name:CAPASSO, RAPHAEL JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:JOHN
Last Name:CAPASSO
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 1:100 HAWLEY LN
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5330
Mailing Address - Country:US
Mailing Address - Phone:203-378-9462
Mailing Address - Fax:203-378-9462
Practice Address - Street 1:100 HAWLEY LN
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5330
Practice Address - Country:US
Practice Address - Phone:203-378-9462
Practice Address - Fax:203-378-9462
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000890152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management