Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2122 | CT |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3270 | MA |
NPI | 1265427983 |
---|---|
Provider Name | Dr. Steven Richard Squillace |
First Address | Somers, CT 06071-1206 |
Second Address | Somers, CT 06071-2160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0353418 | (05) | MA |
4243648 | (05) | CT |
T59381 | (02) | CT |