Provider Demographics
NPI:1730275702
Name:MARGIUS, THOMAS AQUINAS (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:AQUINAS
Last Name:MARGIUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4725
Mailing Address - Country:US
Mailing Address - Phone:203-877-4060
Mailing Address - Fax:203-877-1566
Practice Address - Street 1:122 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4725
Practice Address - Country:US
Practice Address - Phone:203-877-4060
Practice Address - Fax:203-877-1566
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004089907Medicaid
CTT22786Medicare UPIN
CT004089907Medicaid