Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001536 | CT |
NPI | 1063968915 |
---|---|
Provider Name | David Varker |
First Address | Bridgeport, CT 06606 |
Second Address | Stratford, CT 06614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 31/08/2016 |