Provider Demographics
NPI:1245257153
Name:HIMMELSTEIN, AMY
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:HIMMELSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-1902
Mailing Address - Country:US
Mailing Address - Phone:860-582-2166
Mailing Address - Fax:
Practice Address - Street 1:440 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-1902
Practice Address - Country:US
Practice Address - Phone:860-582-2166
Practice Address - Fax:860-582-8044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004133823Medicaid
410000961OtherMEDICARE ID - TYPE UNSPECIFIED
CTD400074192Medicare PIN
410000961OtherMEDICARE ID - TYPE UNSPECIFIED
T22563Medicare UPIN