Marvin a Sodergren PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

000714 Issued in CT

Legal business name

MARVIN A SODERGREN PC

Practice address

850 Hartford Tpke
Waterford, CT 06385-4238

Phone

(860) 444-7441

Fax

(860) 444-1800

NPI assigned

Mar 15, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Marvin Arnold Sodergren, O.D.

Title

Optometrist/Owner

Phone

(860) 456-7426

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1811211279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 PIGEON SWAMP RD",
            "city": "LEBANON",
            "state": "CT",
            "postal_code": "062491333",
            "telephone_number": "860-456-7425",
            "fax_number": "860-456-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 HARTFORD TPKE",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063854238",
            "telephone_number": "860-444-7441",
            "fax_number": "860-444-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVIN A SODERGREN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "SODERGREN",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "ARNOLD",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "860-456-7426",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CT",
            "license": "000714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004023800",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1750364436",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Marquardt
• Urielle Marseille, MD
• Michael C Marshall, LCSW
• Martin L Hellman, OD, Faao, LLC
• Martin L Hellman, OD, Faao, LLC
• Mary C. Beaulieu, OD
• Jeffrey Edward Matyas Sr., LPC
• Mayeda Gynecology, PLLC
• Francis Mayeda, M.D.
• Marissa Elizabeth McCarthy, MS, CSP, LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; 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.