MEDICARE: RICK CROLLA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1027	CT

General Provider Information

NPI Number	:	1740271816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICK CROLLA O.D.

Provider Business Mailing Address
First Line	:	317 MAIN ST
Second Line	:
City	:	NEW CANAAN
State	:	CT
Zip	:	06840-5837
Country	:	US
Telephone Number	:	203-972-3287
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 EAST AVE
Second Line	:
City	:	NEW CANAAN
State	:	CT
Zip	:	06840-5516
Country	:	US
Telephone Number	:	203-966-9480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	09/30/2010

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