Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 20690 | CT |
NPI | 1003814245 |
---|---|
Provider Name | Charles J Oestrich |
First Address | Milford, CT 06460-3352 |
Second Address | Milford, CT 06460-3352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 28/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B83776 | (02) | CT |