Healthcare Provider Details

I. General information

NPI: 1043337835
Provider Name (Legal Business Name): DR. PHILIP M SHAPIRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 12/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ASYLUM ST
HARTFORD CT
06103-2208
US

IV. Provider business mailing address

45 ASYLUM ST
HARTFORD CT
06103-2208
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-2020
  • Fax: 860-522-5577
Mailing address:
  • Phone: 860-522-2020
  • Fax: 860-522-5577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number0621
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: