Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 02135 | CT |
NPI | 1003830308 |
---|---|
Provider Name | Dr. Mitchel Boyd Strand |
First Address | Newington, CT 06111-2318 |
Second Address | Newington, CT 06111-2318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 05/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004087947 | (05) | CT |
T78365 | (02) | CT |