=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689750002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA M MATUSZEWSKI OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 WESTFARMS MALL
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-2633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-561-4189
-----------------------------------------------------
Fax | 860-521-5768
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 WESTFARMS MALL
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-2633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-561-4189
-----------------------------------------------------
Fax | 860-521-5768
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 002013CT
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------