Provider Demographics
NPI:1871621193
Name:CONROD, THOMAS R (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:CONROD
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 1:2300 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2108
Mailing Address - Country:US
Mailing Address - Phone:203-248-3937
Mailing Address - Fax:203-288-5679
Practice Address - Street 1:2300 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2108
Practice Address - Country:US
Practice Address - Phone:203-248-3937
Practice Address - Fax:203-288-5679
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002315152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2301OtherHEALTHNET ID
CT001888867001OtherUNITED HEALTHCARE ID
CT102315OtherCONNECTICARE ID
CT0614004920005OtherCIGNA ID
CT090002315CTOtherANTHEM ID
CTP605594OtherOXFORD HEALTH PLAN ID
CT102315OtherCONNECTICARE ID
CT001888867001OtherUNITED HEALTHCARE ID
410000642Medicare PIN