Paul J Werdell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

771 Issued in CT

Practice address

553 Farmington Ave
Hartford, CT 06105-3048

Phone

(860) 236-5831

Fax

(860) 236-2966

NPI assigned

Jun 17, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033114897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 FARMINGTON AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061053048",
            "telephone_number": "860-236-5831",
            "fax_number": "860-236-2966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 FARMINGTON AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061053048",
            "telephone_number": "860-236-5831",
            "fax_number": "860-236-2966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERDELL",
        "first_name": "PAUL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4024287",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Hartford, CT
• Providers in Hartford, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.