Active NPI
Thomas Paul Misiewicz, OD
- Optometrist
- Enfield, CT
National Provider Identifier
1437201076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 000971
- Practice address
- 25 North Main Street
Enfield, CT 06082-1289 - Phone
- (860) 745-8055
- Fax
- (860) 745-2355
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 000971 | CT | Primary |
Addresses
Primary practice location
25 North Main Street
Enfield, CT 06082-1289
Mailing address
PO Box 1289
Enfield, CT 06083-1289
Phone (860) 745-8055
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0519191 | Other | AETNA | |
| 0596650001 | Other | MEDICARE MATERIALS | |
| 738255 | Other | CT | CONNECTICARE |
| UPIN 27681 | Other | VISION SERVICE PLAN | |
| 0005971059 | Other | TX | AETNA |
| UPIN 27681 | Other | CIGNA | |
| 09000971CT01 | Other | CT | ANTHEM BCBS |
| 11220239 | Other | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000971 | CT | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1437201076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1289",
"city": "ENFIELD",
"state": "CT",
"postal_code": "060831289",
"telephone_number": "860-745-8055",
"fax_number": "860-745-2355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 NORTH MAIN STREET",
"city": "ENFIELD",
"state": "CT",
"postal_code": "060821289",
"telephone_number": "860-745-8055",
"fax_number": "860-745-2355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISIEWICZ",
"first_name": "THOMAS",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CT",
"license": "000971",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0519191",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE MATERIALS",
"identifier": "0596650001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "738255",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VISION SERVICE PLAN",
"identifier": "UPIN 27681",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0005971059",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "UPIN 27681",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "09000971CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11220239",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Enfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.