Provider Demographics
NPI:1871763144
Name:WAYNE M. LEVASSEUR, O.D.
Entity type:Organization
Organization Name:WAYNE M. LEVASSEUR, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEVASSEUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-688-1630
Mailing Address - Street 1:186 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2925
Mailing Address - Country:US
Mailing Address - Phone:860-688-1630
Mailing Address - Fax:860-687-1324
Practice Address - Street 1:186 BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2925
Practice Address - Country:US
Practice Address - Phone:860-688-1630
Practice Address - Fax:860-687-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT900332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0455060001Medicare NSC