Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1752 | CT |
NPI | 1013428754 |
---|---|
Provider Name | Alfredo A Angeles-Puriaman |
First Address | Stratford, CT 06614-5111 |
Second Address | Stratford, CT 06614-5111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2017 |
Last Update Date | 21/10/2017 |