Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 002692 | CT |
N | 152W00000X | Optometrist | TUV006965-1 | NY |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 002692 | CT |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 002692 | CT |
NPI | 1336112770 |
---|---|
Provider Name | Dr. Joseph S. Madrak |
First Address | Shelton, CT 06484-8164 |
Second Address | Shelton, CT 06484-8164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 20/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008035624 | (05) | CT |