Healthcare Provider Details

I. General information

NPI: 1417328139
Provider Name (Legal Business Name): DR JOSEPH S MADRAK OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RIVERSIDE DR #4
SHELTON CT
06484-8164
US

IV. Provider business mailing address

7 RIVERSIDE DR, # 4
SHELTON CT
06484-8164
US

V. Phone/Fax

Practice location:
  • Phone: 203-924-2175
  • Fax: 203-924-9232
Mailing address:
  • Phone: 203-924-2175
  • Fax: 203-924-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateCT

VIII. Authorized Official

Name: DR. JOSEPH S MADRAK
Title or Position: OWNER
Credential: OD
Phone: 203-924-2175