Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001411 | CT |
NPI | 1134754294 |
---|---|
Provider Name | Dorothy Reynolds |
First Address | Fairfield, CT 06825-2406 |
Second Address | Fairfield, CT 06825-2406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2020 |
Last Update Date | 10/03/2020 |