Basic Information
| Provider Information | |||||||||
| NPI: | 1740259969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAGNELLA | ||||||||
| FirstName: | TONIANN | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 499 FARMINGTON AVENUE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606780202 | ||||||||
| FaxNumber: | 8606780224 | ||||||||
| Practice Location | |||||||||
| Address1: | 499 FARMINGTON AVENUE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606780202 | ||||||||
| FaxNumber: | 8606780224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2265 | CT | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 002265 | CT | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 004197168 | 05 | CT | MEDICAID | 1073561767 | 05 | CT | MEDICAID |