Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2019 | CT |
NPI | 1013079706 |
---|---|
Provider Name | James Smyth |
First Address | Vernon, CT 06066-4052 |
Second Address | Vernon, CT 06066-4052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2006 |
Last Update Date | 08/07/2007 |