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General NPI Number Information
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NPI Number | 1184733255
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Entity Type | Individual
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Provider Name | PETER PEGOLO OD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 612 QUAKER LN S SUITE B
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1027
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Country | US
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Telephone | 860-236-1218
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Fax | 860-231-9298
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Provider Business Mailing Address
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Address Line | 612 QUAKER LN S SUITE B
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1027
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Country | US
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Telephone | 860-236-1218
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Fax | 860-231-9298
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | CT02448
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License Number State | CT
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