Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 000645 | CT |
NPI | 1124572813 |
---|---|
Provider Name | Joseph Vanhoose |
First Address | Stratford, CT 06614-5111 |
Second Address | Stratford, CT 06614-5111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2016 |
Last Update Date | 10/08/2016 |