Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001503 | CT |
NPI | 1144680158 |
---|---|
Provider Name | Elda Cone |
First Address | Lisbon, CT 06351-3249 |
Second Address | Lisbon, CT 06351-3249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2016 |
Last Update Date | 03/03/2016 |