Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1498 | CT |
NPI | 1053588095 |
---|---|
Provider Name | James S Lewis |
First Address | Hartford, CT 06103-2208 |
Second Address | Hartford, CT 06103-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2008 |
Last Update Date | 09/05/2008 |