Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1582 | CT |
NPI | 1194173427 |
---|---|
Provider Name | David Robert Matusz |
First Address | Waterbury, CT 06705-1317 |
Second Address | Waterbury, CT 06705-1317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 26/05/2016 |